Outpatient Payer Source Specialist - 40 hrs/wk, Monday - Friday

Job Title:  Outpatient Payer Source Specialist       
Job Location: Omaha           

JOB OVERVIEW

Responsible for verifying, recording, and revising financial payer information and reviewing patient demographic information for TherapyPlus Omaha.  Responsible for obtaining and monitoring authorizations as needed for third party payment.  Responsible for providing and when necessary, explaining patientâ??s insurance benefits and securing an acknowledgement of patientâ??s financial responsibility related to services rendered. Other responsibilities include typing, word processing, faxing, and photocopying.  Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility.


ESSENTIAL FUNCTIONS

• Responsible for obtaining pre-authorizations, referrals and continual authorizations for patients receiving outpatient rehabilitation when necessary.
• Works with clinicians to request extensions from insurance companies when necessary.
• Responsible for verification of any insurance information that has not been completed upon admission.
• Responsible for obtaining verification of insurance benefits and completion of insurance benefit forms.
• Responsible for obtaining detail information to facilitate payment such as third party administrator and case manager requests.
• Responsible for communication with insurance workers compensation case managers, employers and third party administrators to ensure the best benefits and coverage possible for patients.
• Ensuring that the insurance verifications are documented and put into the patient's chart for the clinicians to read.
• Follow up to additional authorizations and/or physician referrals.
• Communicats with Patient Financial Services for understanding insurance company procedures and changes
• Communicate with various insurance companies, attorneys, hospitals, other extended care facilities, and governmental agencies to obtain and/or verify necessary demographic, financial and liability information.
• Follow instruction from supervisor to perform other functions as assigned in order to achieve the goals within the department as well as within the facility.
  
  QUALIFICATIONS
• High school equivalency with one year post-high school education and two years work experience required.
• Additional relevant work experience would be considered in lieu of formal post-high school education.
• Working knowledge of Medicare, Medicaid, Workers Compensation and commercial insurance required.
• Must have working knowledge of personal computers, word processing software, preferably Word and other Microsoft office programs (Access, Outlook, Excel, etc.), and office machines.
• May be required to obtain/maintain CPR for Health Care Provider/CPR for Professional Rescuer, based off clinical need and delegation.