Surgical Care Affiliates

Insurance Verification/Scheduler

US-GA-Atlanta
Type
Full-Time
# of Openings
1

Overview

SCA owns and/or provides management services to 205 ambulatory surgery centers, surgical hospitals, and hospital surgery departments, in partnership with approximately 2,800 physicians and in affiliation with 105 health systems. SCA's clinical systems, service line growth strategies, benchmarking processes, and efficiency programs create measurable advantage for surgical facilities – clinically, operationally, and financially. 

 

Facility Description:  Perimeter Surgery Center of Atlanta is a growing, multi-specialty ambulatory surgery center located in Atlanta. Specialties include Neuro-spine, Orthopedics, General, Plastics, Oculo-plastic, ENT, GI, and Pain.  

Accountabilities / Responsibilities

The Insurance Verification/Scheduler is responsible for ensuring scheduled procedures are on the patient’s insurance covered list and/or the patient meets self-pay criteria. The Insurance Verification teammate will be responsible for verifying insurance coverage, eligibility, benefits, obtaining authorizations and pre-certs as required by the individual insurance company.  The teammate will verify that all scheduled procedures are on the ASC procedure listing.  The Insurance Verifier will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals.  The Verification/Scheduler will enter approved patients into the scheduling system promptly and efficiently.

 

Insurance Verification:

  1. Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician office and/or the patient.
  2. Determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance.
  3. Utilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information.
  4. Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class.
  5. When the patient’s insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers.

Authorization:

  1. Obtain authorizations from insurance companies/physician offices. Ensure complete and accurate information is entered into the patient accounting system and the procedure scheduled, date of service and facility name are on the authorization. Ensure the authorization has not expired.
  2. Enter authorization into patient accounting system. Include the name/CPT codes effective date of the authorized procedures.
  3. Ensure high cost implant/supply or equipment rental is included on authorization.
  4. Check insurance company approved procedure lists/medical policies. If procedure is not payable, notify patient. If patient wants to proceed, obtain signature on Medicare ABN or other non-covered notification form.

Financial Orientation:

  1. Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable.
  2. Acceptance of in-network benefits for out-of-network payers must be pre-approved by SCA Compliance Dept.
  3. Be familiar with individual payer guidelines and the process of collecting over the counter payments/deductibles/co-pay/co-insurance. Knowledge of payer contracts including Medicare,
  4. Medicaid and other government contracts and guidelines and workmen’s compensation fee schedule.
  5. Contact the patient and communicate the center financial policy

 

Qualifications

  • Associates Degree or equivalent from two-year college or technical school; or six months to one-year experience in a medical office, hospital, outpatient surgery center or related field; Computer experience, Excel, Word, Medical Applications. Experience with computer scheduling.
  • Good communication, organizational and interpersonal skills

Please send resumes to:donna.smith@scasurgery.com

2017-3802

 

                                                                                   

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