Responsibilities

This job is responsible for completing insurance verification of benefits, obtaining behavioral authorizations, completing pre-registration and registration as needed, answering questions via phone and email from front desk staff and patients. An incumbent conducts verification, authorization through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently.

Essential Function

Applies a thorough understanding/interpretation of Verification of Benefits (VOB) to, confirm patient eligibilityCommunicates effectively over the phone and through written correspondence with providers, clinical staff, clinic managers, and payers to obtain VOB, and behavioral authorizations.Applies understanding and knowledge of medical terminology, payer guidelines, CPT codes, ICD-10 codes to ensure appropriate behavioral authorizations are obtainedRecognizes when additional assistance is needed to resolve complex issues and escalates appropriately and timely through defined communication and escalation channels.Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.Works the claim edit work queues timely and efficiently to correctly resolve the error.Assists with unusual, complex or escalated issues as necessary.Accurately documents behavioral authorizations, VOB, and co-pay amounts.
Qualifications

Education and Experience

Education Level

Education Details

Grace Period

And/Or

Experience

Experience Details

Required/Preferred

And/Or

NONE

Required

Licensure and Certifications

Licenses/Certifications

Compact Accepted

Grace Period

Required/
Preferred

And/Or

None (None)

N/A

upon hire

Required

Overview

CHI Health strives to care for you the way you care for your patients. 

We understand you have personal responsibilities outside of your profession and also care about your well-being. 

With you in mind, we offer the following benefits to support your work/life balance:

Health/Dental/Vision Insurance  Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care Voluntary Protection: Group Accident, Critical Illness, and Identity Theft  Employee Assistance Program (EAP) for you and your family Paid Time Off (PTO)  Tuition Assistance for career growth and development Matching 401(k) and 457(b) Retirement Programs Adoption Assistance Wellness ProgramsFlexible spending accounts

From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.