Patient Coverage Verification Specialist

JOB SUMMARY:

The Patient Coverage Verification Specialist (PCVS) is responsible for providing the highest level of customer service to CBHS patients and other staff. They will verify all patient coverages for scheduled appointments that are in Athena Practice or Phreesia. The PCVS may rotate service lines quarterly to ensure they are versed in all aspects of coverage verification, authorization processes, and workflows by service line. They are responsible for ensuring Chase Brexton receives maximum payment for services rendered through any coverage the patient may have, while informing the staff of all available financial assistance to the patient. They will also reach out to patients who may need to revalidate their sliding scales. 

MAJOR DUTIES AND RESPONSIBILITIES:

Communication

•    Strong interpersonal and telephone communication skills.

•    Clearly and effectively interacts with staff of the care team or insurances to communicate information. 

•    Assures timely follow-up and communication.

•    Reaches out to patients who have a sliding scale that is about to expire to or may have expired to inquire about coverage

•    Responsible for providing accurate and complete data input for preauthorization requests while providing exceptional customer service to CBHS staff, patients, caregivers, and family members that may be contacted. 

•    Tracks and follows up on all preauthorization requests to Insurances or Providers. 

Patient Focus

•    Provides prompts, efficient and personalized assistance to meet the requirements, requests, and coverage needs of patients.

•    Identifies patient coverage needs and issues and works to resolve the problems prior to the arrival of the patient for their appointment.

•    Explains basic insurance terminology and procedures related to the patient obtaining care from the providers.

•    Create and maintain a patient-centric atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment.

Workplace Computers and Equipment 

•    Handle telephone and written inquiries. 

•    Enter information into Patient Management System and EMR.

Compliance Quality & Policy

•    Maintains patient confidentiality

•    Complies with federal and local patient privacy laws.

•    Verifies patient and or/guardian identification.

•    Document services by initiating appropriate forms, entering client data into the EMR, and ensuring all documentation is appropriately signed and dated. 

•    Carry out various quality assurance activities, such as collecting client feedback regarding problems with insurance reimbursement

Teamwork

•    Assists in coverage for other service lines.

•    Performs other tasks as needed. 

•    Maintains open relationships and lines of communication with co-workers

•    Present ideas and suggestions when opportunities for improvement present of existing services based on interactions.  

•    Serves as a resource and subject matter expert for their defined area of work.

•    Works closely with care team and providers to process any prior authorizations.

Checking, Examining, and Recording

•    Verify eligibility, coverage, and benefits for all scheduled patients.

•    Determines any copays/coinsurance/deductible amounts that are patient responsibility and makes a note in the appointment comment for the Patient Service Representative to collect. 

•    Stays 2 days ahead of verifying coverage for appointments. Since Medicaid coverage is month to month, ensures Medicaid is verified at the beginning of every month and works to get caught back up to the 2 day window of coverage verification. 

•    Arranges treatment authorizations from payers when needed for payment, and tracks authorizations and notifies providers when a new authorization is needed (if applicable to payer). 

•    Detects and corrects errors, completes forms, obtains needed information and maintains logs and files.

Willingness to Learn

•    Maintains knowledge of insurance information as it relates to provider credentials. 

Planning and Organizing

•    Confirm patient insurance coverage prior to initial appointment and document benefits for all new insurances in Practice Management System. 

SKILLS AND ABILITIES

•    Must possess excellent interpersonal skills

•    Knowledge of medical terminology preferred

•    Basic understanding of HIPAA and PHI

•    Basic navigational knowledge of electronic medical record applications such as CPS12

•    Must have good time management skills, be organized, self-motivated

•    Possess excellent written and verbal communication skills

•    Maintain a high level of productivity and confidentiality

•    Work well in a team environment. 

•    Can enter data with ability to check accuracy of detail work such as correct spelling of names, numbers, dates and times.

•    Ability to handle multiple tasks at once without mistakes or diminution of professional demeanor and customer service. 

•    Effectively able to prioritize and maintain workflow.  

•    Ability to function in a high volume, multiple task environments, possibly in a closely shared workspace.  

•    Demonstrate self motivation and the ability to work with a high degree of independence.

•    Ability to effectively and efficiently solve problems as presented in real time.

•    Strong organizational and task prioritization skills. 

EDUCATION AND/OR EXPERIENCE:

Required: High school, G.E.D. or equivalent.

Required: One year of customer service experience and coverage verification experience.  

Desired: Experience with Electronic Medical Records Systems

Desired :Bilingual