About this role
Duties & Responsibilities:
1. Work queue Management for Error Resolution and Accuracy of Payers:
- Assumes responsibility for complex cases
- Contacts Insurance Co directly to validate needed corrections or updates
- Direct contact with Liaison and/or Patient/Clinical /Family/Caregiver as needed
- Clinical Team involvement as needed to include Clinician, Assistant Manager and Manager (documented in WQ notes)
- Specific notes added to deferred cases for peer to peer f/u, case details and status
- Coordination with billing/operations department for all inter-departmental issues including Change of Payers.
2. Coordination of Benefits:
- Knowledge of COB issues and assumes responsibility for resolution
- Knowledge of EPIC navigation for documentation review
- Works directly with Liaison/Family/Caregiver for accurate COB
- Specialist will have full ownership
- MSPQ pulled, completed and verified. If unable to determine, attempts to verify with the patient/ family/ caregiver will commence.
3. Re-Verification:
- Knowledge of reason for re-verification, annually, monthly, or for potential insurance changes
- Completed on-line or by phone
- Plan Mismatch- ticket required for EPIC mapping
- Connectivity – check status, re-run and use eSolutions for Medicare
- High school diploma or GED
- Keyboard and data entry skills
- Excellent communicative and customer service skills
- Experience in Insurance Verification with Homecare and Hospice preferred.