Documentation & Insurance Verification Representative in Huntington Beach, CA at Byram Healthcare

Date Posted: 4/21/2018

Job Snapshot

Job Description

  • Responsible for maintaining exemplary levels of customer service in all interaction in accordance to Byram Healthcare�s Mission and Vision.
    • Answers questions from customers, clerical staff, insurance companies, and physician offices.
    • Identifies and resolves patient complaints.
    • Explains and collects co-pays, deductibles and other patient balances, when needed.
    • Makes patients fully aware of financial obligations and eligibility for programs that may provide financial aid.  Provides patient education regarding third party coverage and liabilities
  • Verification and Collection of Patient Records
    • Conducts outbound calls to obtain appropriate documentation for reimbursement of orders shipped.
    • Verify customer benefits via phone, fax, and/or web portal.
    • Reviews and approves documentation received by third parties, for submission to payors.
    • Demonstrates knowledge of insurance payers and the use of electronic systems for verification purposes.  Uses electronic systems and payer websites for verification of insurance, authorizations and referrals. 
    • Verifies, and obtains any missing information and documents patient insurance information at time of service. This includes verifying health insurance coverage, eligibility dates, obtaining in and out of network benefit amounts, out of pocket limit, deductible information, life time maximum, co-payment amount, and the like.
    • Obtains prior authorization for inpatient and outpatient services from government, commercial, and state agencies, as needed.
    • Submits timely electronic, verbal notifications, and clinical documentation in accordance with contractual requirements.
    • Documents activities within ERP system in a clear, accurate and timely manner.
  • Continuous evaluation, troubleshooting, and feedback of processes and procedures.
    • Demonstrates critical thinking, research abilities and the ability to work with multiple insurance payors to secure benefits.
    • Communicates potential issues and trends to Group Team Lead and initiates resolution steps.
    • Responsible for following guidelines associated with Byram Healthcare�s Financial Clearance Policies and Procedures.
    • Works collaboratively across teams, with peers, and the operations department. 
    • Performs additional duties as assigned, in support of revenue cycle operations

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