Work Type: Active - Benefit Eligible and Accrues Time Off Exempt: No
Work Schedule: Monday - Friday Work Hours per Biweekly Pay Period:80
Shift Time: Location: Medical Center, US:FL:Lakeland
Summary: Verifies and interpretes insurance benefits and obtains insurance authorizations as appropropriate for all potential patient admissions. Coordinates and supports process for obtaining continued insurance authorization from managed care payers during the patient's stay on the unit. Works closely with payers to expedite patient admissions process. Supports unit utilization management efforts to ensure regulatory compliance and optimal reimbursement.
Detailed responsibilities: * People At The Heart Of All We Do - Fosters an inclusive and engaged environment through teamwork and collaboration. - Ensures patients and families have the best possible experiences across the continuum of care. - Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created. * Safety And Performance Improvement - Behaves in a mindful manner focused on self, patient, visitor, and team safety. - Demonstrates accountability and commitment to quality work. - Participates actively in process improvement and adoption of standard work. * Stewardship - Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. - Knows and adheres to organizational and department policies and procedures. * Standard Work Duties: Patient Insurance Coordinator - Verifies insurance benefits for all potential patient admissions to the unit - Uses expert knowledge of insurance rules and regulations to verify, interpret and communicate insurance eligibility and benefits to patients, physician's office staff, hospital staff and others. Ensure that the appropriate insurance payer order is established in the patient record. - Obtains initial insurance authorization from managed care payers for potential patient admissions to unit. Process includes initiating authorization, communicating with insurance case managers, providing requested clinical documentation, receiving authorization information, and communicating authorization to admissions coordinators. Responsibilities also include oversight and coordination of additional requests for clinical information, physician peer to peer follow ups, etc. - Works closely with payers to expedite patient admissions process. - Calculates patient uninsured amount using all available tools and communicates insurance benefits and patient financial responsibility to the patient or guarantor as appropriate while also verifying registration information. Collaborate with the Hospital Eligibility vendor and/or the Financial Counseling team as appropriate for assistance with uninsured/under-insured patients. - Maintains a thorough knowledge of the revenue cycle process, applicable CMS regulations, appropriate commercial and liability contractual terms, and other related regulatory requirements. - Collaborates with the unit Care Coordinators to assist with completion of EQ Health billing. Responsible for utilization management used to obtain ongoing insurance authorizations for IRF continued length of stay reviews. - Medical record documentation review to ensure unit is meeting all required regulatory requirements. - Distributes patient satisfaction surveys and completes follow up calls to obtain data from prior IRF patients. - May support Bannasch adminstrative tasks as time allows.
Qualifications & Experience
Education: Essential: * High School or Equivalent Nonessential: * Associate Degree
Education equivalent experience: Nonessential: * In health related field or LPN diploma
Other information: Essential Experience: - External candidates - External candidates - Two years of experience in an acute inpatient rehabiliation, hospital, or physician office setting, with an emphasis on verifying insurance eligibility, benefit interpretation and obtaining authorization/pre-certification for services; Two years of Medical Assistance or LPN clinical experience with strong interest in insurance coordination. - Internal Candidates - One year of experience in Patient Access or related position; Two years of Medical Assistance or LPN clinical experience with strong interest in insurance coordination. - Ability to work with diverse groups including physicians, physician office staff, clinicians, patients, family members and other community members.
Experience Preferred: - An ideal candidate would have strong background in clinical knowledge and 3 years of experience in an acute inpatient rehabiliation, hospital, or physician office setting, with an emphasis on verifying insurance eligibility and benefit interpretation, obtaining authorization/referral and/or pre-certification for services.
Preferred Certifications: Certification of medical terminology. Medical Assistance or LPN Diploma
Internal Number: 5123
About Lakeland Regional Health
Lakeland Regional Health is committed to providing patient-focused, health care services while continuing to improve the quality of care to our patients, families, guests and physicians.