Job Description
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where out patents live. Steward - the largest privately held health care company in the U.S. - owns and operations 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lies through the company's managed care and health insurance services. The total number of paneled lives within Steward's integrated care network is projected to reach 3 million in 2018.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Description
The role of the Insurance Verifier is to provide exceptional care to patients and customers while offering clinical support to healthcare providers. The Insurance Verifier works with patients to obtain proper insurance authorization and sees that their needs and expectations are met. Insurance Verifiers are responsible for ensuring the smooth operations in the fast paced environment of the clinic with the goal of a positive patient experience with every encounter.
Key Responsibilities
- Meets individually with all patients to determine insurance benefits
- Reviews criteria required for pre-authorization of surgery
- Collects and submits all required information to insurance carriers and follow-ups to ensure receipt and approval
- Schedules surgeries and pre-op appointments with patients and follows patient until all accounts receivables are in for surgery
- Serves as a resource to patients and their families who are receiving care as part of the treatment plan
- Assists with front and back office duties as required
- Completes assigned training and education
- Performs other duties as determined by the Practice Manager or Clinic Director
Minimum Requirements:
- High School diploma or GED equivalent is required
- Demonstrated knowledge of medical terminology
- Demonstrated ability to communicate effectively on the phone, in writing and via email
- Ability to exercise discretion on sensitive and confidential matters
- Demonstrated computer skills with data entry software
*Institutional accreditation and degree obtainment will be verified upon hire
Preferred Qualifications:
- Three or more years experience in an outpatient clinic or other healthcare setting
- One or more years of demonstrated insurance pre-authorization experience
- Demonstrated experience using electronic medical records (EMR)
Physical Requirements:
- Sit up to 6-8 hours a day
- Stand and walk up to 4-6 hours a day
- Speak and listen to internal and external customers
- Bend to reach supplies/materials, reach with hands and arms throughout the day
- Lifting, pushing, pulling
- Grasp and manipulate tools
- Key information into a computer workstation, use computer peripheral tools
Benefits Offered
We have many plans with various deductibles, which can cover individuals or families so you can customize a plan that will work for you! Steward Health Care works with Blue Cross Blue Shield of Massachusetts to provide affordable health insurance for our employees. Our Health Plans Highlights are:
- Deductibles will not apply to services provided by a Steward provider (Tier 1).
- Office visits copays will be $0 when a member uses a Steward Provider (Tier 1).
- Mental Health and Substance Abuse office visits will be $0 for all In-Network providers (Tier1, Tier 2, and Tier 3).