Insurance Validation Representative-Horizon Healthcare Services
3310 Horizon Health Services Operations
Patient Account Services
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To ensure patient benefits are confirmed accurately so patient can make an educated financial decision prior to beginning home infusion therapy. Provides complete and accurate financial estimates to hospital staff, Horizon Liaisons and Patient. Communicates information timely in order to meet all necessary time frames. Manage the communication from the numerous hospitals so no referrals are lost.
Working hours for this position are 8:30 am to 5:00 pm. Work every 9th Saturday with the prior Monday off.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Serves as the primary point of contact between the liaisons/ owner hospitals/ and other referrals to ensure accurate insurance verification for requested services
- Identifies and resolves customer registration issues including but not limited to, charge inquires, insurance inquiries, ICD10 coding and patient status changes
- Handles escalated referral issues in a professional manner, when necessary
- Ability to independently resolves issues
- Effective communication within all departments in HHS and referrals sources
- Informs supervisor or manager of any problems or issues
- Enter referrals accurately and within allocated time
- Initiates initial authorization, re-authorizations when necessary to assist/cover the Authorization department.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above
- Helps foster an environment of continuous improvement and positivity by suggesting ideas to leadership.
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- High school diploma or equivalent.
- Two (2) years of clerical, customer service, or administrative support experience in a highly customer-oriented organization.
- Strong written and verbal communication and organization skills.
- Excellent computer skills including Microsoft Office Products.
- Ability to apply strong analytical qualities.
- Prior experience in accounts receivable and collections, preferably in the home health medical field.
- Two (2) years of registration experience, point of service collection, insurance validation, understanding of compliance /regulatory guidelines and order release process(es).
Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.
The position requires strong concentration skills. The individual must have the ability to voluntarily sustain concentration to a task over an extended period of time as a result of an effortful and usually deliberate heightened and focused state of attention.
New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.
The position requires that an individual be able to learn new tasks quickly and effectively. Job requirements change frequently. The ability to understand and carry out detailed, involved instructions is mandatory.
Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.
The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.
Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.
Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.
Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.
Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies
Software: Microsoft Office Products
Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%
- Sit: Continuously
- Stand: Occasionally
- Walk: Occasionally
- Bend: Rarely
- Push: Rarely
- Pull: Rarely
- Kneel/Squat: Occasionally
- Reach: Rarely
- Twist: Rarely
- Balance: Rarely
- Climb: Rarely
Lifting: Degree of physical exertion is: Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.
Sensory Abilities specifically required:
Exposure to hazardous conditions/ materials is negligible.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.
Posted on 01/06/2021