VERIFICATION SPECIALIST - North Therapy (Outpatient) in North Canton, Ohio at Aultman Health Foundation

Aultman Hospital

The primary responsibility of the verification specialist is to perform verification prior to outpatient Therapy visits to ensure accurate and reliable front-end patient demographic and insurance information, along with authorization requirements in order to produce clean claims and eliminate back-end denials.

Outpatient Therapy Services includes Occupational Therapy, Physical Therapy and Speech Therapy. Each clinic provides varying specialty services within the scope of these fields, such as LSVT, FCE's or Vestibular rehabilitation. Some clinic locations may also provide wellness services such as Tai Chi, exercise/balance classes, massage therapy or Reiki.

• High school graduate or equivalent.

• Clerical experience and Microsoft Office proficiency are preferred.

• Experience in office setting or billing setting preferred.

• Knowledge of basic medical terminology, anatomy, physiology and disease process.

• Knowledge of insurance payers.

• Obtain and maintain current American Heart Association (AHA) training in Basic Life Support (BLS) utilizing Resuscitation Quality Improvement (RQI) is required.

• Excellent telephone and interpersonal communication skills are required.

• Ability to communicate professionally to team members in multiple formats (verbal, handwritten, instant message and email).

• Demonstrates the ability to utilize computer hardware, software programs, and/or the Internet (Ex. EMR, government & commercial on-line programs, access insurance carrier information, use excel or word, etc.).

• Ability to clearly document key insurance information in medical record as directed.

• Demonstrate understanding of general billing guidelines for therapy services in outpatient setting.

• Demonstrates the ability to meet all critical responsibilities and expectations of the Registration/scheduler position. May be required to provide routine weekly coverage or in cases of urgent need, as identified by the Therapy leadership team.

• Verification of all patient insurance information at least two days in advance of initial visit for prescheduled visits, or same day for add-on visits. This includes but is not limited to:
  • Checking active coverage eligibility and in-network status.
  • Copayment or Coinsurance Amount.
  • Policy coverage and limitations such as: CPT code restrictions, visit limits, personnel restrictions, per day unit charge maximums.
  • Visit authorization requirements
  • Verification that all information obtained is correctly entered into the appropriate electronic registration systems (e.g. Cerner) utilizing approved clearance systems for error resolution timely.
  • Follow up with patients directly if there are discrepancies, missing information or if insurance is ineligible, prior to their appointment. Restart verification process if new information obtained.
  • Timely cancellation of appointments in scheduling system due to insurance issues to ensure accuracy of daily schedules, along with notification to patient.
  • Document accurately in EMR in approved manner: verified insurance name along with non-covered services/restrictions and any authorization requirements or no authorization requirements for clinician/registration awareness.

• Authorization tracking and submissions: Obtain a prior authorization if required by patient's insurance plan once evaluation has been completed and treatment plan has been established by the therapist. This includes but is not limited to:
  • Downloading/printing needed medical records (evaluation/cert letter, provider order, outcomes measure data) and submitting through specific insurance preferred routes (portal, fax, telephone review).
  • Clarifying necessary evaluation information or requested CPT codes/quantities, frequency of care with evaluating therapist or therapy leadership in therapist absence.
  • Maintaining tracking methods to ensure all new evaluations requiring auth have had auth submitted and approvals/denials received.
  • Communication of denials and options with therapist, patient and leadership PRN.
  • Submission and tracking of auth renewals in collaboration with therapist.

• Assist with creation, modification and maintenance of reference materials for staff to aid in proper identification of insurances and related authorization requirements as requested.

• Assist as directed with review of adjustments and denials.

• Assist with training and mentoring of new registration and/or verification staff.

• Any other duties relating to the business operation of the practice that may be assigned by the manager.

• The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.

• Hours of operation with shifts as assigned including occasional overtime, on-call or off-shifts (evenings and/or weekends) scheduled as necessary to meet clinic needs.

• Lunch and break periods must be coordinated with other staff members to maintain adequate staffing during hours of operation.

• Subject to frequent interruptions and changes in priority of duties throughout the day.

• Subject to emergency and other crisis situations.

• Interactions with patients and visitors with physical and/or cognitive disabilities

Category II - Includes tasks that involve no exposure to blood, body fluids, or tissues, but employment may require performing unplanned Category I tasks. The normal work routine involves no exposure to blood, body fluids, or tissues by exposure or potential exposure may be required as a condition of employment. Appropriate protective measures will be readily available to every employee engaged in Category II tasks.

Demands

Frequency

Remarks

Lifting 0-10 lbs

Frequent 34-65%

Lifting 10-20 lbs

Occasional 10-33%

Lifting 20-35 lbs

Occasional 10-33%

Lifting 35-50 lbs

Never

Lifting 50-75 lbs

Never

Lifting 75-100 lbs

Never

Lifting over 100 lbs

Never

Forward Reaching

Frequent 34-65%

Overhead Reaching

Occasional 10-33%

Standing

Occasional 10-33%

Walking

Occasional 10-33%

Sitting

Continuous 66% of the day

Climbing

Never

Stairs/Ladder

Occasional 10-33%

no ladder

Bending/Stooping

Occasional 10-33%

Twisting/Turning

Occasional 10-33%

Kneeling/Squatting

Occasional 10-33%

Crawling

Never

Pushing/Pulling 0-10 lbs

Occasional 10-33%

Pushing/Pulling 10-20 lbs

Occasional 10-33%

Pushing/Pulling 20-35 lbs

Occasional 10-33%

Pushing/Pulling 35-50 lbs

Never

Pushing/Pulling 50-100 lbs

Never

Pushing/Pulling over 100 lbs

Never

Carrying 0-10 lbs

Occasional 10-33%

Carrying 10-20 lbs

Occasional 10-33%

Carrying 20-35 lbs

Occasional 10-33%

Carrying 35-50 lbs

Never

Carrying 50-100 lbs

Never

Carrying over 100 lbs

Never

Grasping/repetitive sustained

Continuous 66% of the day

Fine motor coordination

Continuous 66% of the day

Vision: Near/Far/Color

Continuous 66% of the day

Hearing: ordinary conversation/other

Continuous 66% of the day

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. The organization is an EEO/AA Employer M/F/Disability/Vet.

The organization will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on the organization or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Aultman Human Resource Department and request such an accommodation.