Patient Benefits Specialist

Employment Type

: Full-Time

Industry

: Healthcare - Allied Health



Job Description Summary:

Responsible for performing the appropriate procedures to verify patient eligibility, coordinate benefits, run test claims, submit initial authorization and determine patient coverage/responsibility for services and testing and implementation of new plan business.

Job Description:

Job Responsibilities (listed in order of importance and/or time spent)

Performs Insurance Verification of benefit coverage on all of patient's insurance plans for each service being provided.

Obtains and documents in the system all information related to coinsurance, copay, deductibles, authorization requirements, etc.

Creates documentation required to service the patient per policy and payer guidelines.

Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.

Obtains initial authorization prior to admitting the patient for all services for any insurance plan that has authorization requirements.

Obtains reauthorization as necessary, reviews physician orders from pharmacy to determine if authorization is required on changes / additions to therapy for patients that are already on service.

Supervisory Responsibilities

Does this position have supervisory responsibilities?

(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

No X

Yes

Basic Education and/or Experience Requirements

High School Diploma with 2 years of experience in patient registration or revenue cycle management 1 year of similar experience with an Associate’s Degree, LPN or Pharm Tech license.

Basic Qualifications

Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check and/or printing worksheets).

Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane and/or print functions).

Travel Requirements: (if required)

NA

Preferred Qualifications & Interests (PQIs)

LPN, RD or Pharm Tech licensure and/or experience

Previous Infusion Medical Billing/Collections or Intake/Admissions Experience.

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.


Launch your career - Create your profile now!

Create your Profile

Loading some great jobs for you...