Patient Service Representative - Front Office Outpatient Rehabilitation Office

Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours:

Work Shift:

Summary

The Insurance Verification Specialist supports outpatient rehab office staff by researching and verifying patient health insurance eligibility interpreting insurance benefits for a specific service and documenting this information into EMR system. Insurance verification specialist identifies when insurance authorization is required initiates prior authorization request and submits supporting clinical documentation to obtain approval for services provided by outpatient rehab clinics.

Essential Functions

Working in office full time position.

Research and verify patient health insurance coverage and eligibility. Register patient coverage accurately within EMR to ensure timely billing and reimbursement from payer

Obtain and interpret specific program benefits under patient health insurance plan by using online portals or phone calls to payer

Concisely and accurately document patient benefit information within EMR system to generate patient estimates

Effectively communicate benefit information to patients as needed. Answer detailed patient questions regarding out-of-pocket costs as indicated under their specific insurance plan

Initiate prior authorization requests with insurance payer submit clinical documentation that supports medical necessity for request and follow up on authorization status prior to patients first scheduled visit

Maintain clear timely communication with front office staff regarding insurance benefit barriers that may prevent patient conversion or delay prior authorization approval prior to first patient visit

This document is not an exhaustive list of all responsibilities skills duties requirements or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor subject to reasonable accommodation.

Employment Qualifications

Required Minimum Education:

High School Diploma or GED

Minimum Years and Type of Experience:

1 year of experience in insurance verification

Other Knowledge Skills and Abilities Required:

Comprehensive understanding of insurance eligibility and coverage requirements contract benefits and medical terminology. Customer focused with strong interpersonal skills courtesy and tact with patient and rehabilitation staff. Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents. Must be able to demonstrate a working knowledge of personal computers and proficient in computer applications and other electronic technologies. Must demonstrate a positive and professional demeanor along with strong verbal and written communication skills including proper phone etiquette. Understand and follow HIPAA regulations. Able to organize workload and manage time efficiently. Must be able to handle potentially stressful situations and multiple tasks simultaneously. Must be able to successfully complete additional job related training when offered.

MercyHealth is an equal opportunity employer.

Many of our opportunities reward* your hard work with:

• Comprehensive affordable medical dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Employer contributions to retirement savings plan when eligible
• Paid time off
• Educational Assistance
• And much more

*Benefits offerings vary according to employment status.

Department:

It is our policy to abide by all Federal and State laws as well as the requirements of 41 CFR 60-1.4(a) 60-300.5(a) and 60-741.5(a). Accordingly all applicants will receive consideration for employment without regard to race color national origin religion sex sexual orientation gender identity age genetic information or protected veteran status and will not be discriminated against on the basis of disability. If youd like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown Ohio or Bon Secours Franklin Virginia; Petersburg Virginia; and Emporia Virginia which are Affirmative Action and Equal Opportunity Employer please email . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process please contact The Talent Acquisition Team at .