Surgical Care Affiliates

  • Insurance Verification Specialist

    Job Location US-NE-Omaha
    Type
    Full-Time
    # of Openings
    1
  • Overview

    SCA, a leader in the outpatient surgery industry, strategically partners with health plans, medical groups and health systems across the country to develop and optimize surgical facilities. SCA operates more than 210 surgical facilities, including ambulatory surgery centers and surgical hospitals, in partnership with approximately 7,500 physicians. For more information on SCA, visit www.scasurgery.com.

     

    Facility Description: Lakeside Surgery Center is a freestanding Ambulatory Surgery Center dedicated to the delivery of care to patients in need of surgical services in an outpatient setting.  Employment for Lakeside Surgery Center is through Surgical Care Affiliates (SCA), one of the largest national outpatient surgery providers based out of Illinois.  While Lakeside Surgery Center is affiliated with CHI, it is not apart of Lakeside Hosptial.

     

    Accountabilities / Responsibilities

    The insurance Verification teammate is responsible for ensuring scheduled procedures are on the patients 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 individuals 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 principles.

     

    The Insurance Verification teammate will be responsible for calculating co-insurance estimates per the payer contract as applicable and amounts due from self-pay patients are according to the center self-pay guiltiness, Policies and Procedures. The teammate will enter the verification, eligibility, and benefit information in the patient accounting system to include date, time and method used to obtain the verification/eligibility information for each patient. The documentation will include the amount expected from the patient on or before the date of service.

     

    The Insurance Verification clerk is responsible for communicating insurance benefit information and financial responsibility to each patient during a Pre-Registration Financial Orientation call prior to the date of service. The verifier is responsible for verifying the patient demographic and insurance information along with subscriber information and secondary insurance as applicable during the Pre-Registration Financial Orientation Call.

     

    SCA strives to provide excellent customer service to all patients and physicians by promptly, accurately, and efficiently verifying insurance, self-pay accounts and notification to patients prior to the date of service.

     

    Key Responsibilities:

     

    Insurance Verification:

    • 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.
    • Determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance.
    • 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.
    • Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class.
    • When the patient’s insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers.
    • SCA’s goal for each patient’s insurance verification is complete and accurate. The insurance verifier will document the findings in the patient account and will contact the patient with either estimated co-insurance, co-pay and or deductible amounts due on or before the date of service as applicable
    • The Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patient’s prior to the date of service to review, Physician Ownership, Advance Directives and Patient Rights.

    Authorization:

    • 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.
    • Enter authorization into patient accounting system. Include the name/CPT codes effective date of the authorized procedures.
    • Ensure high cost implant/supply or equipment rental is included on authorization.
    • 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:

    • Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable.
    • Acceptance of in-network benefits for out-of-network payers must be pre-approved by SCA Compliance Dept.
    • 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,
    • Medicaid and other government contracts and guidelines and workmen’s compensation fee schedule.
    • Contact the patient and communicate the center financial policy

     

    Qualifications

    • Associates Degree or equivalent from two-year college or technical school; or six month to one year experience in a medical office, hospital, outpatient surgery center or related field
    • Computer experience, Excel, Word, Medical Applications
    • Self-Starter
    • Good Phone etiquette

    Please send resumes to Kbull@lakesideasc.com 

    2018-4689

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