Insurance Coordinator Cardiac Rehab

Benefits

Additional Information

If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-22745 Facility: LOC0001 - 55 Fogg Road55 Fogg Road Weymouth, MA 02190 Department Name: SSH Cardiac Rehab Status: Part time Budgeted Hours: 0 Shift: Day (United States of America) The Insurance Coordinator is responsible for the admission process and insurance verification for patients and referrals. Responsible for and ensures compliance with third party payer requirements and acts as liaison between the department and the insurance company's advocates for the patient to ensure appropriate receipt of benefits and coordination of rehabilitation services. Compensation Pay Range: $22.12 - $29.77 ESSENTIAL FUNCTIONS 1 - REQUESTING SERVICES/PROVIDING PROGRAM INFORMATION a. Responds to incoming calls requesting services and information regarding programs offered for all Rehab Services, completing insurance intake information from patients, physicians and other sources. b. Identifies and coordinates appropriate services 2 - PRE-AUTHORIZATION a. Creates an accurate database for all patients and verifies third party coverage. b. Implements new insurance office procedures to streamline referral process c. Obtains pre-authorizations/certification for services per payer guidelines before initial date of service d. Enters into the data base and files in patients' medical record referral information as it is received e. Ensures complete collection of referral information, including insurance coverage utilizing on-line verification technology f. (Passport) when possible, obtaining authorization information including number of visits approved, and dates services are covered g. Accurately and legibly completes insurance tracking sheet for each patient and each discipline h. Obtains pre-authorization/certification through various means (fax, telephone, website) for services per payer guidelines i. Discussing financial liability and schedule accordingly, in a confidential manner when indicated j. Develop effective relationships with payer representative to facilitate coverage and problem resolution k. Provides documentation for third party payer benefits in a timely manner l. Understands coordination of benefits and acts as a liaison between patients and clinicians. m. Verifies and ensures accuracy of orders with regard to appropriateness for services, identification of a diagnosis, date and signature 3 - EXTENSION PROCESS/DENIALS a. Ensures that patients receive optimum benefits b. Overturns 100% of any denial notification received c. Compiles and submits appeal letters on receipt of denial d. Obtains continuing service approvals and provides/faxes clerical data/information to third party payers to ensure reimbursement/approval within 24 hours of request e. Consistently ensures that documentation received for extension approvals are in the computer/medical record on date received and communicated to patient to ensure no interruption in care f. Responds to, investigates, collects and submits appeal letters to third party payers for benefits and successful reversal on 95-99% if denials received g. Compiles and submits appeal letters within 2-3 business days h. Tracks insurance caps and patient treatment does not exceed monetary allowance as outlined by insurance company i. Communicates relevant issues to clinician, patient and family in a timely fashion 4 - OBTAINING LETTERS OF MEDICAL NECESSITY a. Work with patient accounts to obtain letters of medical necessity for all patients that are part of the Uncompensated Care Pool (UCP/Free Care) b. Form letter for medical necessity will be faxed to MDs office each day patient is here for services up to third visit. If the letter is not returned by third visit, call will be placed to the MD c. If self-pay at time of registration, insurance office must meet with patient to advise patient to contact our Financial Counseling Department to apply for Mass Health/UCP, or work out payment plan 5 - CUSTOMER SERVICE/CHECK -IN a. Greets and acknowledges all patients and visitors, both in office and on telephone, with professionalism and directs to appropriate services. b. Initiates and follows through with service recovery process while keeping all team members informed as needed c. Monitors patient flow and attendance throughout the day frequently checking the waiting area and sign-in log, keeping patients informed of delays as needed d. Fosters a pleasant and professional office environment in keeping with Culture of Service Excellence standards e. Answers telephones by the third ring, using department accepted greeting and in professional tone in accordance with the hospital's telephone etiquette standards f. Checks phone messages each hour and responds to call within same business day 6 - PRE-REGISTRATION AND REGISTRATION a. Completes pre-registrations and registrations with respect for patient privacy, and understands the impact of data accuracy