Responsibilities
- Manage Jira tasks related to insurance verification and utilization review.
- Collaborate with team members to track and document progress on tasks and issues.
- Accurately read and interpret VOB documents to confirm patient eligibility and coverage.
- Understand and utilize CPT/REV codes for determining covered services.
- Review facility facesheets to cross-check patient information with insurance details.
- Help perform simple eligibility checks for patients using online payer portals or scripts.
- Support the team in confirming insurance coverage for new admissions.
- Use call scripts to confirm eligibility and relay information to patients and facility staff.
- Follow up with insurance companies, patients, and facilities to ensure that required authorizations are in place.
- Utilize scripts to set up retro reviews or appeals as necessary.
- Maintain accurate and thorough documentation in Jira, KIPU, and other systems as needed.
- Submit retro reviews and appeals, ensuring all required documentation is included.
- Document follow-up calls, communications, and outcomes according to organizational standards.
- Navigate KIPU to manage patient discharges and ensure all discharge documentation is completed.
- Fax discharge paperwork to relevant parties and call in discharges to the appropriate entities.
- Pull medical records from KIPU as needed for reviews or appeals.
- Understand and manage the process for obtaining and extending authorizations.
- Follow up on outstanding authorizations and resolve discrepancies with insurance carriers.
Qualifications
- Strong analytical skills to determine the validity of refund claims and draft appeals effectively.
- Ability to Identify and resolve issues related to refund requests and claim reimbursements in a timely manner.
- Clear and coherent in both written and verbal communication skills to effectively conduct discussions to resolve refund issues and appeals.
- Continuously seeks ways to improve the accuracy and efficiency of refund processing.
- Exhibits sound and accurate judgment in evaluating refund claims and making decisions on whether to approve, deny, or appeal refund requests based on careful consideration of available information.
- Strong time management skills to handle multiple requests and develop realistic action plans to ensure timely and accurate resolution of refund issues.
- Observes safety and security procedures related to handling sensitive payment information to maintain data integrity and confidentiality.
Screening Criteria
- High school diploma or an equivalent combination of education and related work experience.
- At least two (2) years of experience in medical billing, healthcare insurance verification or related roles.
- Must have a stable employment history.
