VERIFICATION SPECIALIST in ALLIANCE, Ohio at Aultman Health Foundation

Purpose of Position:

• The purpose of this position is to accurately create the patient registration, and obtain insurance authorization to increase patient satisfaction, reduce denials and increase cash flow.

Skills and Qualifications:

• High school graduate, minimum
• Comprehensive knowledge of Patient Registration and Revenue Cycle
• Knowledge of DME and managed care concepts
• Experience in CPT, HCPCS and ICD coding.
• Refined communication skills, both written and oral
• Ability to cope with the stress of the position and deadlines imposed.
• Refined organization skills with a well-developed style of diplomacy
• Ability to function independently, displaying personal integrity and always maintaining confidentiality.
• Professional manner and appearance in accordance with the Aultman Hospital policies
• Comprehensive knowledge of computer and the software systems utilized by the registration and patient financial services departments.

Primary Responsibility:

• Verify and register all patient information for DME.

• Verify the payer source of all accounts when registered.
  • Determine eligibility and benefits.
• Verify that all necessary documentation has been received to bill (per Medicare guidelines)
• Coordinate all authorizations and pre-certifications by directly contacting payer.
• Follow up on all Authorization requests in a timely manner.
• Maintain up to date information regarding the necessity of authorizations for products by payer.

Job Specific Requirements:

• Begin the registration process when an order is received.
• Verify patient demographics and insurance.

• Initiate the verification and pre-certification of insurance benefits as soon as possible post by electronic eligibility systems, payer website or telephone.
• Convey required information to third party payers to meet requirements assuring payment for services.
• Work cooperatively with physician’s offices to obtain necessary information.
• Contact payers and/or Phys offices to secure prior authorization for all products and services.
• Accurately record information in all systems as a method of communication with the billers to facilitate correct billing of services.
• Function as a team member, working closely with other colleagues and billing team to maintain the most efficient processes.
• Identify areas for inter and intradepartmental operational improvements.

Physical Requirements Addendum:

KEY:

O = Occasionally – 00-33% of the work shift

F = Frequently = 34-66% of the work shift

C = Constantly = 67-100% of the work shift

N = Not essential job requirement

Requirements for PAC Team Staff member:

O = Standing

O = Walking

N = Lifting (70 pounds)

N = Carrying (70 pounds)

N = Pushing (70 pounds)

N = Stooping/Bending

O = Twisting/Turning

N = Kneeling

N = Crawling

O = Reaching Up/Reaching Forward