Job Description:
This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires.Job Essentials1. Obtains insurance eligibility and benefit information using various phone and on-line resources.
2. Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.
3. Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.
4. Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.
5. Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
6. Immediately refers 'at risk' admission to eligibility, i.e., out of network, underinsured, max benefits, etc.
7. Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.
8. Maintains a satisfactory level of performance and adherence to workload standards.
9. Estimates cost of service using ICD-9 or CPT codes.
10. Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility.
11. Performs calculations using insurance benefit information to accurately estimate patient responsibility.
12. May lead and/or train new employees in account preparation and review functions.
Minimum Qualifications
Two years of customer service experience.
- and -
Demonstrated good communications and computer skills.
Preferred Qualifications
Demonstrated knowledge of medical terminology.
- and -
Experience in admitting, billing, collections, and/or insurance verification.
- and -
Bi-Lingual Spanish speaking.
- and -
Demonstrated knowledge of CPT/ICD-9 codes.
Physical Requirements:
Interact with others requiring the employee to communicate information.- and -
Operate computers and other office equipment requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Location:
Central Office - Las VegasWork City:
Las VegasWork State:
NevadaScheduled Weekly Hours:
40The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$17.85 - $24.26We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.