INSURANCE VERIFIER MMCSO - Centegra Health System - Woodstock, IL

INSURANCE VERIFIER MMCSO - Centegra Health System - Woodstock, IL -

Beneath the overall supervision of the Monetary Clearance Middle (FCC) Supervisor. Contacts insurance corporations, physicians, and sufferers to make sure that correct affected person demographic and insurance info is collected, and that a monetary clearance willpower could be made. Informs sufferers of their rights, the Centegra Health System monetary insurance policies, and collects affected person liabilities.

Meets division staffing wants which embrace weekends and holidays.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Offers wonderful customer support to all events by responding to buyer requests/ points in a proactive and well timed method.

Shows Centegra Service Excellence requirements.

Shows constructive intra/ inter-departmental communication expertise.

Every day obligations embrace:
Verifying eligibility and advantages utilizing digital and telephonic assets

Acquiring pre-certifications, authorizations, and referrals to make sure managed care compliance for vital appointments

Fulfilling notification necessities for inpatient admits

Contacting sufferers to request and acquire monies due, together with monies due from earlier visits, and issuing receipts

Establishing cost plans for sufferers unable to pay monies due in full

Getting into the knowledge gathered into the pc system

Performing another perform deemed essential to carry out monetary clearance

Making use of important considering expertise to determine and resolve issues proactively to maximise reimbursement

Exhausting all options when trying to make a monetary clearance willpower

Different duties might embrace:
Working intently with numerous departments all through the well being system, together with Scheduling / Pre-Registration, Monetary Counseling, Registration, Billing, Medical Employees, and the Cost Discrepancy Unit

Figuring out and speaking insurance plan updates to CMS Billing Managers for enter into the insurance grasp

Offering affected person schooling regarding affected person rights, regulatory necessities and monetary insurance policies

Exchanging needed info with the doctor workplaces, hospital, nursing houses, and different departments to insure an entire and correct registration report

Getting ready oral/ written communications together with periodic standing reviews

Answering telephones, dealing with calls or directing calls to applicable space. Performing different associated clerical duties

Documenting notes in pc system relating to all conversations with sufferers, insurance firm representatives, pre-certification notification representatives, and outcomes of assortment efforts

Performing different duties assigned by Supervisor

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Learn and write, carry out arithmetic calculations, and possess wonderful interviewing and communication expertise. Sort 60 wpm and possess pc literacy.

Maintain highschool diploma or equal required, some school programs most popular.

Have one yr service-associated expertise required. Three years service-associated expertise most popular. Roughly one to 2 years expertise registering / billing in a medical setting or insurance claims processing most popular.

Medical terminology and/or insurance terminology most popular.

Robust interpersonal expertise needed so as to successfully talk with all clients (sufferers, guests, hospital employees and others).

Capacity to deal with, diffuse, and resolve troublesome conditions, together with buyer complaints.

Staff oriented to help Centegra staff members as wanted.

Flexibility and resiliency to adapt to numerous affected person dynamics.

Extremely motivated and objective-oriented to satisfy efficiency necessities, together with capability to deal with a number of duties concurrently and to prioritize worklists appropriately.

Robust analytical expertise to course of admissions and appropriately calculate affected person shares.

Self-motivated and powerful organizational expertise; means to deal with a number of duties.

Bodily potential to carry out useful necessities as detailed.

The above is meant to explain the overall content material of and necessities for the efficiency of this job.

It isn’t to be construed as an exhaustive assertion of duties, obligations or necessities.

EOE M/F D/V

Qualifications

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