Job Summary: 

• Perform insurance pre-authorization, verification, and document information accordingly.
• Verify all patient eligibility, authorizations, benefits, and claim information with insurance companies and 3rd party payers prior to the patient's initial physical therapy visit.
• Responsible for covering the front desk.
• Communicate verification information with appropriate personnel for preparation for the patient's initial visit.
• Identify all patient accounts accurately based on what PPO, HMO, or other Managed Care Organizations the patient's insurance plan might fall under.
• Contact the physical therapy office with updates on benefit verification information, requests additional information, and insurance cards.
• Accurately completes data entry necessary, including authorizations and benefits.
• Compile and collect an accurate list of contracted and uncontracted insurances.
• Communicate with the Central Billing Office to clarify contractual agreements if they differ from insurance verification.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Eligibility Verification (Hard Skills)
• Front Desk (Soft Skills)
• Insurance Communication (Soft Skills)
• Managed Care Knowledge (Hard Skills)
• Office Contact (Soft Skills)
• Data Entry (Hard Skills)
• Insurance Lists (Hard Skills)

Job Summary: 

• Maintain strict participant confidentiality.
• Process payments, balance deposits and send self-pay bills.
• Answer and correspond with participants, Local Union, Pharmacies, Pharmacy vendors and PPO networks.
• Compose and send accurate and professional written communications to participants.
• Review eligibility guidelines and Summary Plan Descriptions regarding active, retiree and terminated policy holders.
• Process participant refunds for overpayments.
• Request monthly reports for over-age dependents, Medicare eligible participants, delinquent accounts and send appropriate correspondence.
• Request additional forms or information not supplied by the participant.
• Review court documents such as divorce decrees, custodial court documents, marriage certificates, etc.
• Respond to requests from members for special forms.

Skills on Resume:

• Confidentiality Maintenance (Soft Skills)
• Payment Processing (Hard Skills)
• Participant Communication (Soft Skills)
• Written Communication (Soft Skills)
• Eligibility Review (Hard Skills)
• Refund Processing (Hard Skills)
• Report Requests (Hard Skills)
• Court Document Review (Hard Skills)

Job Summary: 

• Responsible for phone calls, walk-ins, email and fax.
• Refer problems and complex or questionable claims, data entry and Pension supervisor.
• Maintain current knowledge of plan documents, including eligibility rules, benefit provisions and payment procedures.
• Assist in the training of other personnel.
• Assist the Pension department in determining if the retiree is eligible for continued benefits and sending appropriate correspondence.
• Implement new retiree and COBRA premiums and send correspondence, update rate sheets.
• Change and add new class codes.
• Utilize BCBS facets systems in order to add and maintain eligibility for new and terminated policyholders.
• Learn and navigate through pharmacy and PPO websites.

Skills on Resume:

• Phone Correspondence (Soft Skills)
• Problem Referral (Soft Skills)
• Plan Knowledge (Hard Skills)
• Staff Training (Soft Skills)
• Eligibility Determination (Hard Skills)
• Premium Implementation (Hard Skills)
• Class Code Management (Hard Skills)
• System Navigation (Hard Skills)

Job Summary: 

• Process all incoming referrals in a timely manner.
• Verify all referral information is complete and accurate, then confirm client eligibility is current.
• Enter new clients in KanTime and the Referral Report.
• Verify patient benefits based on plan guidelines.
• Cognizant of private insurance terms and able to effectively communicate that to families.
• Contact families regarding their availability for treatment, special requests and status of therapist staffing.
• Maintain accurate and current communication documentation in KanTime and Rosters.
• Staff new clients by coordinating with the therapist in the appropriate geographic area and experience.
• Maintain all processing workflow and all aspects required to initiate therapy services.
• Create and scan electronic documentation to KanTime and create client charts.
• Maintain open communication with families, therapists and physicians regarding delays.
• Comply with all safety policies, practices, and procedures and report unsafe activity to the supervisor.

Skills on Resume:

• Referral Processing (Hard Skills)
• Eligibility Verification (Hard Skills)
• Data Entry (Hard Skills)
• Benefit Verification (Hard Skills)
• Insurance Communication (Soft Skills)
• Family Coordination (Soft Skills)
• Workflow Management (Hard Skills)
• Safety Compliance (Soft Skills)

Job Summary: 

• Communicate effectively with patients and co-workers.
• Adhere to safety policies and procedures.
• Use good judgment and maintain the confidentiality of information.
• Responsible for working as a team player.
• Demonstrate tact, resourcefulness, patience and dedication.
• Accept direction and adhere to policies and procedures.
• Recognize the importance of adapting to the various patient age groups (adolescent, adult and geriatric).
• Work in a fast-paced environment.
• Responsible for meeting corporate deadlines.
• React calmly and effectively in emergency situations.

Skills on Resume:

• Patient Communication (Soft Skills)
• Safety Adherence (Hard Skills)
• Confidentiality Maintenance (Soft Skills)
• Teamwork (Soft Skills)
• Professional Demeanor (Soft Skills)
• Policy Compliance (Hard Skills)
• Patient Adaptability (Soft Skills)
• Deadline Management (Hard Skills)

Job Summary: 

• Handle high-volume new patient insurance verifications for HMO, Discount Plans, and PPO.
• Retain specific avenues and verification methods.
• Complete PPO breakdowns in a timely fashion for emergency patients.
• Maintain a well-organized system of operation with appropriate team members.
• Communicate and document all issues and resolutions effectively.
• Enter data using dental practice management software.
• Generate reports for all activities.
• Clear communicator with team members, team leads, patients and management.
• Work with minimal supervision/direction and the ability to multitask.
• Take direction, initiate business activities and work with management staff and peers.
• Take part in training and other learning opportunities to expand knowledge of the company and position.
• Meet daily, weekly, and monthly department goals set forth by management.
• Adhere to all company policies and procedures, and abide by HIPAA regulations.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Verification Methods (Hard Skills)
• PPO Breakdown (Hard Skills)
• Operational Organization (Soft Skills)
• Issue Communication (Soft Skills)
• Data Entry (Hard Skills)
• Report Generation (Hard Skills)
• Team Communication (Soft Skills)

Job Summary: 

• Review pending claims report and create claims in POS.
• Ensure that all necessary documentation is scanned into Diary Management.
• Responsible for working on pre-conversion Aging for respective regions.
• Support to the clinics for any insurance-related questions, including benefit interpretation.
• Request and obtain Worker’s Compensation approvals.
• Train clinic staff on insurance-related matters in the assigned region.
• Respond to patient inquiries via telephone and email.
• Determine the best method for problem resolution, meeting patient needs and organizational guidelines.
• Coordinate issue resolutions with other departments.
• Gather patient personal and billing information for database entry and scheduling.
• Load insurance into the EMR system.

Skills on Resume:

• Claims Processing (Hard Skills)
• Document Management (Hard Skills)
• Aging Report Handling (Hard Skills)
• Benefit Interpretation (Hard Skills)
• Worker’s Comp Approvals (Hard Skills)
• Staff Training (Soft Skills)
• Patient Communication (Soft Skills)
• Issue Resolution (Soft Skills)

Job Summary: 

• Review the work queue in a timely manner in order to prioritize requests.
• Verify insurance eligibility and benefits via online portals/software applications/phone.
• Call WC/Auto adjusters or attorneys in order to obtain additional information.
• Communicate patient benefits in a timely manner following the appropriate workflow.
• Accurately documents specific details related to patients’ benefits and policy requirements.
• Resolves all requests, inquiries and concerns in an expedient and respectful manner.
• Assist in maintaining manuals and other documentation.
• Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits.
• Verify insurance benefits, working with IPA, Medical Group, and Medi-Cal insurance.

Skills on Resume:

• Queue Management (Hard Skills)
• Eligibility Verification (Hard Skills)
• Info Retrieval (Soft Skills)
• Benefit Communication (Soft Skills)
• Accurate Documentation (Hard Skills)
• Request Resolution (Soft Skills)
• Manual Maintenance (Hard Skills)
• Benefit Coordination (Hard Skills)