Under the general direction of the Manager of Insurance Coordination and/or designee, and in accordance with corporate goals, this position verifies all existing patient insurance information, documents, communicates and corrects billing system to reflect
accurate coverage as per payor specifications and regulations. The position is essential to maximize revenue and reduce the number of uncollected account receivables.
• Accurately enters, verifies and sequences all incoming referrals for Lifetime Care and all related entities. Adheres to time frames noted within policy to create an efficient and effective admission flow which includes proper documentation.
• Accesses information from various sources including on line verification systems such as EPACES and commercial payer websites and provider lines to access the most current information.
• Re-verifies insurance for each open and active patient on service. Uses all systems as appropriate for the payor/insurance plan, on a monthly basis or as needed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Level II – Performs similar functions as level I, as well as:
• Organizes the inquiries from Patient Financial Service Department staff as well as clinical staff to determine proper, accurate and timely sequencing of payors to insure accurate billing.
• Researches and resolves issues resulting in necessary changes to patients’ accounts and the liability for payment of services provided.
• Accurately documents patient insurance information, determines proper sequence of coordination of benefits, clearly communicates to all departments and corrects billing system to reflect accurate coverage.
• Contacts resources to resolve discrepancies in insurance information, including patients, physician’s offices and County Department of Social Services (DSS) offices.
• Communicates with peer nurses, team managers, and supervisors via telephone or e-mail to discuss case and the necessary steps that need to be taken in order for payment to occur.
• Shares information and knowledge learned (with co-workers) while working in the various on-line systems with other departmental staff and management.
• Works collaboratively with Home Care Coordinators and Insurance Coordination staff to rectify coordination of benefit issues.
Level III – Performs other functions as level II, as well as:
• Conducts research to obtain Medicare numbers when the patient is enrolled in a Medicare Advantage Plan and no Medicare number has been provided.
• Performs analysis from existing systems, work flows and provides recommendations to improve efficiency.
• Understands appropriate prioritization of issues and when to elevate problems to management.