Verification Specialist

Alternate Solutions Health Network • Dayton, OH

1d • Remote

About The Position

At Alternate Solutions Health Network, the Verification Specialist examines patient eligibility for home care services and keeps patients and necessary parties informed throughout the verification process. The organization provides skilled home care and hospice services in patients’ homes, partnering with health systems to support coordinated care.

The role completes data entry for new patient referrals and investigates the type and level of insurance coverage. It communicates with patients and families about insurance verification, billing, covered services, and out-of-pocket costs; contacts insurance companies as needed; evaluates eligibility for ordered services; verifies physician Face-to-Face Encounters for billing requirements; and completes hospital-hold workflows, which may include faxing a summary to the hospital and following up with hospitalized patients. The specialist follows agency policies and procedures, stays current with CMS guidelines, completes required workflow, reporting, and documentation, and updates appropriate staff throughout the process.

This is a fully remote position for someone local to Kettering, Ohio. The schedule is Sunday through Wednesday, 8:00 a.m. to 6:30 p.m., with on-call and holiday rotation. Compensation starts at $17.00 per hour.

Requirements

• High school graduate or equivalent.
• Two years of experience in insurance verification or the healthcare field.
• Knowledge of CMS guidelines.
• Familiarity with medical terminology.
• Capable of meeting all physical demands.
• Compassionate communication and a positive attitude.
• Patience when working with patients, families, physicians, and coworkers.
• Attention to detail, observation, and ability to follow directions.
• Problem-solving skills and ability to develop solutions and determine a course of action.
• Technological skills, including researching equipment online, learning new software and database systems, and using Microsoft Office.
• Must be local to Kettering, Ohio.

Responsibilities

• Communicate with patients and their families about insurance verification and billing.
• Explain which services are covered by insurance and what out-of-pocket costs patients may incur.
• Contact insurance companies to verify patient information and coverage as needed.
• Evaluate patient eligibility to receive ordered services.
• Verify physician Face-to-Face Encounters for billing requirements.
• Complete hospital-hold workflows, which may include faxing summaries to hospitals and following up with hospitalized patients.
• Follow agency policies and procedures and stay current with CMS guidelines.
• Perform workflow and data reporting in accordance with CMS guidelines.
• Complete and submit required documentation within company requirements.
• Update appropriate staff throughout the verification process.
• Complete data entry for new patient referrals and investigate insurance coverage.

Benefits

• Medical insurance with plan flexibility.
• Dental insurance with plan flexibility.
• Vision insurance with plan flexibility.
• Paid time off for eligible teammates.
• Optional 401(k) participation; the company has historically matched 401(k) contributions.
• Company-paid life insurance.
• Disability insurance.
• Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED