Healthcare Payor Change/ Reverification Representative

CenterWell

3d • $43,000 - $56,200 • Hybrid

About The Position

Become a part of our caring community. As a Healthcare Payor Change/ Reverification Representative, you will report directly to the Payor Change/Reverification Supervisor. You will have the following responsibilities: Daily auditing of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met. Monitoring and reviewing weekly reverification runs for Medicare and Non- Medicare. Verifying patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for timely, accurate revenue recognition. Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate. Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue. Preparing and submitting invoices to Accounts Payable for reimbursement and performing follow up to ensure accurate, timely payments are made to our facility partners. Coordinating, reviewing, and analyzing documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing. Ensuring all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements. Ensuring all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents. Alerting appropriate team members at the Site regarding late or missing documents required for billing. Establishing and maintaining positive working relationships with Sites, Nursing Home Facilities, and AR Teams. Maintaining the confidentiality of patient/client and agency information at all times. Maintaining accurate and up to date information for all vendor and nursing facility contracts. Keeping information in an orderly manner readily accessible for review. Presenting status as requested. Assuring compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures. Acting as an information resource for any hard revenue generation issues or system issues. Assuring the completion and coordination of work in an associate's absence, or as needed to maintain departmental standards. Use your skills to make an impact.

Requirements

• 1 or more years of accounts receivable insurance claims experience.
• 1 or more years of eligibility experience.
• Proficient in using computers and Microsoft Office applications, including Word, Excel, Outlook and Teams.
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Associate's degree.
• 1 or more years of payor alignment experience.
• 1 or more years of insurance reverification experience.

Responsibilities

• Daily auditing of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.
• Monitoring and reviewing weekly reverification runs for Medicare and Non- Medicare.
• Verifying patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for timely, accurate revenue recognition.
• Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate.
• Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.
• Preparing and submitting invoices to Accounts Payable for reimbursement and performing follow up to ensure accurate, timely payments are made to our facility partners.
• Coordinating, reviewing, and analyzing documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing.
• Ensuring all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.
• Ensuring all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.
• Alerting appropriate team members at the Site regarding late or missing documents required for billing.
• Establishing and maintaining positive working relationships with Sites, Nursing Home Facilities, and AR Teams.
• Maintaining the confidentiality of patient/client and agency information at all times.
• Maintaining accurate and up to date information for all vendor and nursing facility contracts.
• Keeping information in an orderly manner readily accessible for review.
• Presenting status as requested.
• Assuring compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.
• Acting as an information resource for any hard revenue generation issues or system issues.
• Assuring the completion and coordination of work in an associate's absence, or as needed to maintain departmental standards.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree