Payer Services Specialist

2 days ago


Louisville, Kentucky, United States Trilogy Health Services Full time
About the Role

We are seeking a highly skilled Payer Services Specialist to join our team at Trilogy Health Services. As a Payer Services Specialist, you will play a critical role in ensuring timely authorization and reimbursement for our residents' services.

Responsibilities
  • Perform tasks related to prior authorizations, recertifications, and insurance verifications for potential admissions and therapy services.
  • Coordinate residents' access to services by gathering information to obtain verification and authorization from various insurance payers.
  • Track and troubleshoot issues to ensure timely authorization is obtained and limit risk of nonpayment.
  • Validate and verify patient's active insurance benefits, demographics, prior authorization requirements, network status, and financial information.
  • Initiate on-line verifications and/or make phone contact with Insurance Carriers and Plan Administrators to validate patient's benefits for primary and secondary coverage.
  • Responsible for completing the Preadmission Financial Verification prior to admission in a timely manner.
  • Determine if override requirement is necessary based upon company set thresholds and campus specific contract details.
  • Provide campus team support explaining residents' benefits and requirements.
  • Verify and understand various insurance company benefits for Skilled Nursing and Outpatient Therapy services.
  • Identify patient financial responsibility.
  • Document complete and accurate data relating to all necessary eligibility, benefits, and precertification information for the appropriate Matrix Care database fields after admission or services rendered.
  • Maintain a thorough understanding of all major insurance plans and network/contracted provider verification requirements.
  • Ensure billing information and authorization requirements are communicated to the campus and prior authorization intake so that MatrixCare is set up correctly and claims can be billed accurately.
  • Negotiate Single Case Agreements with managed care and other insurance carriers for reimbursement.
  • Assist in researching escalated issues from payers, case managers, revenue cycle team or campuses in a timely and effective manner and provide audit of process to identify system or process failures.
Qualifications
  • High School diploma or equivalent.
  • Bachelor's degree or higher in accounting or business or related field preferred.
  • Minimum of five (5) years healthcare insurance experience in a healthcare, senior living industry, long-term care environment preferred, healthcare billing or managed care organization.
About Trilogy Health Services

We are a senior living provider with the continuous goal of being the Best Healthcare Company in The Midwest. We offer a competitive 401(k) match, student loan repayment, and more. Our Home Office team is based in Louisville, Kentucky, and we are looking for a Payer Services Specialist to report directly to our Director of Payer Relations and Auth Svcs.



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