Benefit Verification Representative Outpatient Pain Management/40 hours/Wallingford

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation.  We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve.  Our Mission:  To enhance health, maximize function and transform lives.  Our values: Integrity, Compassion, Accountability, Respect and Excellence.  These values guide us in providing quality patient care and transforming the lives of our patients.

Job Summary:  The Benefits Verification Representative acts as a primary designate to assist the patient and/or representative and hospital staff with financial clearance process for services.  Optimizes hospital reimbursement through gathering accurate information on insurance and self-pay sources.

Verification of Insurance:

• • Uses HIPAA compliant practices to ensure active insurance coverage for each patient.
  • Provides detailed benefit information including but not limited to OOP expense, referral requirements and authorization requirements.
  • Documents detailed notes within the system in a timely manner.
  • Provides notification of inactive insurance in a timely manner to ensure the least financial impact to the organization.
  • Creates GFE using the charge master when applicable.
  • Submits monthly batch reports for re-verification of active insurance.

 Authorization:

• • • Confirms existence and appropriate contact information for authorization requirements for each payer.
    • Submits required clinical documentation to payer for authorization.
    • Creates and tracks authorized visits in a timely manner.
    • Provides feedback and notates the system with authorization visits information 

Review Denials:

• • • Review denials specific to payer related causes to help overturn and recoup revenue.
    • Communicates effect of the denials to the clinics supervisor and front desk when appropriate.
    • Submits for back auth when appropriate in a timely fashion.
    • Track and trends denial root causes in an effort to minimize instances.
    • Stays up to date on payer rules, requirements and coverage determination specific to the services that Gaylord provides.

Financial Stewardship

• • • Responsibly completely responsibilities in a manner that is efficient and minimizes cost to the organization without sacrificing integrity and quality.
    • Working within their team and surrounding departments to utilize the resources provided by the organization in an effort to help achieve financials goals and ensure long-term financial health.
    • Ensure that the completion of tasks are done completely and accurately the first time in an effort to eliminate any instances of re-work.
    • Gather appropriate insurance information as well as point of sell collections at the appropriate times in the revenue cycle experience in an effort to efficiently secure revenue due to the organization.

  IT IS ICARE

• • • Innovation: Embracing creativity and new ideas to improve processes and outcomes.
    • Teamwork: Collaborating effectively with others to achieve shared goals and objectives.
    • Inclusion: Fostering an environment where everyone feels valued and supported.
    • Safety: Prioritizing the well-being and security of patients, individuals and communities.
    • Integrity: Acting with honesty and transparency in all interactions and decisions.
    • Compassion: Showing empathy and kindness towards others, especially in challenging situations.
    • Accountability: Taking responsibility for actions and outcomes, ensuring reliability and trust.
    • Respect: Treating others with dignity and consideration, valuing their perspectives and contributions.
    •  Excellence: Striving for the highest quality in performance and achievements

Qualifications: 

• • • Associate's degree preferred and 2 years related experience and/or training or equivalent combination of education and experience.

    • Proficient in Micro Soft Office software.  Proficient in Practice Management Systems.  Excellent organizational skills. Knowledge of coding and medical terminology. Multi-tasking, flexibility, telephone skills, custo