Patient Coverage Verification Specialist

Chase Brexton Health Care•Baltimore, MD

2d•$21 - $25

About The Position

The Patient Coverage Verification Specialist (PCVS) - Dental is responsible for providing the highest level of customer service to CBHS patients and other staff. They will verify all patient coverage for scheduled appointments in Athena Practice. They will also provide patient financial responsibility for each appointment. They are responsible for ensuring Chase Brexton receives maximum payment for services rendered through any coverage the patient may have. They will also reach out to patients who may need to revalidate their sliding scales and communicate this to the eligibility specialist team.

Requirements

High school, G.E.D. or equivalent.
One year of customer service experience and coverage verification experience.
Excellent interpersonal skills.
Basic understanding of HIPAA and PHI.
Basic navigational knowledge of electronic medical record applications such as CPS12.
Good time management skills, be organized, self-motivated.
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.

Nice To Haves

Knowledge of medical terminology preferred.
Experience with Electronic Medical Records Systems.
Bilingual.

Responsibilities

Verify all patient coverage for scheduled appointments in Athena Practice.
Provide patient financial responsibility for each appointment.
Ensure Chase Brexton receives maximum payment for services rendered through any coverage the patient may have.
Reach out to patients who may need to revalidate their sliding scales and communicate this to the eligibility specialist team.
Communicate clearly and effectively with staff of the care team or insurances.
Assure timely follow-up and communication.
Reach out to patients who have no coverage to inquire about any new plans or assist with scheduling with Eligibility Specialist.
Provide 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.
Track and follow up on all preauthorization requests to Insurances or Providers.
Provide prompt, efficient and personalized assistance to meet the requirements, requests, and coverage needs of patients.
Identify patient coverage needs and issues and work to resolve the problems prior to the arrival of the patient for their appointment.
Explain 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.
Handle telephone and written inquiries.
Enter information into Patient Management System and EMR.
Maintain patient confidentiality.
Comply with federal and local patient privacy laws.
Verify 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.
Assist in coverage for other service lines.
Perform other tasks as needed.
Maintain open relationships and lines of communication with co-workers.
Present ideas and suggestions when opportunities for improvement present of existing services based on interactions.
Serve as a resource and subject matter expert for their defined area of work.
Work closely with care team and providers to process any prior authorizations.
Verify eligibility, coverage, and benefits for all scheduled patients.
Determine any copays/coinsurance/deductible amounts that are patient responsibility and make a note in the appointment comment for the Patient Service Representative to collect.
Stay 3 days ahead of verifying coverage for appointments.
Ensure Medicaid is verified at the beginning of every month and work to get caught back up to the 2 day window of coverage verification.
Arrange treatment authorizations from payers when needed for payment, and track authorizations and notify providers when a new authorization is needed (if applicable to payer).
Detect and correct errors, complete forms, obtain needed information and maintain logs and files.
Maintain knowledge of insurance information as it relates to provider credentials.
Confirm patient insurance coverage prior to initial appointment and document benefits for all new insurances in Practice Management System.