Verification Specialist

Verification Specialist

05 May 2019

Verification Specialist

Vacancy expired!

Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to 10 clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP and YES Prep schools. Legacy is committed to driving healthy change in our communities.Job DescriptionThe Patient Account Representative’s primary responsibility will be to verify patient eligibility, determine appropriate benefits and to obtain insurance pre-authorization prior to the patient’s exam date and time. The Representative will work in a corroborative, team environment by establishing strong working relationships with Payors, patients, referring physicians, business office, and clinic staff. The Representative must also display strong detailed oriented skills with the proven ability to multitask; handling multiple patient pre-authorization requests at a time. Insurance and Medical terminology will be used daily. Basic knowledge of insurance carrier guidelines is required.Essential FunctionsUses real time work list to prioritize workload in obtaining patient insurance verification and authorization prior to the scheduled exam date and time.Coordinate with Emdeon for electronic verifications.Establish and maintain all verification records for audit purposes.Responsible for verification of patient insurance eligibility daily.Determine individual insurance plan benefits for scheduled exams / BH testing.Obtain any required clinical history from referring physician in order to obtain authorization.Adheres to Documentation Guidelines pertaining to status of patient benefits and/or authorization.All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately in the patient’s medical record in Centricity.Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.Adheres to all HIPAA Guidelines.Provide assistance to Clinic Staff, Scheduling Staff, and other appropriate Departments regarding Authorization and Eligibility.Stay informed; establish method and communicate any updates and/or changes in Payor authorization requirements.Participate in Billing, Eligibility and front desk meetings as needed.Attends scheduled up-training courses as needed; communicates updates to appropriate staff.Establishes and communicates authorization processes and changes in workflow.Serve as a back-up to Billing Specialist as needed.Performs other related duties as assigned or requested.Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.Education & Training RequirementsHigh School diploma or equivalent qualifying experience preferred.Work Experience RequirementsPrevious experience in a healthcare setting within insurance/billing is preferred.Benefits

9 Holiday + 1 Floating Holiday


403b Retirement Plan

Medical / Vision / Dental (if eligible)

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