Patient Access & Eligibility Specialist

Ozarks Medical Center; West Plains (MO); On-site; USD 45,000 - 65,000; Full time

Job summary

Ozarks Medical Center in West Plains, MO is seeking a Billing Compliance Specialist to perform insured account compliance checks for admitted patients and ensure accurate documentation for Medical Records review. You will verify diagnosis codes and procedures in the order checker, obtain necessary authorizations, and support compliant pre-certifications in line with payer requirements.

You will also review insurance coverage, determine primary payer when needed, and participate in special

Responsibilities

• Compliant checks on admitted patients' accounts to ensure accuracy.
• Verify diagnosis codes and procedures in the order checker, ensuring documentation for Medical Records review.
• Complete Medicare Secondary Payer Questionnaire for all Medicare-eligible patients.
• Verify insurance eligibility and benefits.
• Obtain authorizations and pre-certifications for admitted patients per patient insurance plan.
• Verify pre-admission/pre-certifications/insurance verification to support accurate billing and collections.
• Understand and adhere to Medicare, Medicaid, Managed Care and commercial payer guidelines for pre-authorization and pre-certification.
• Review and ensure accuracy of patient insurance coverage information and determine primary payer when COB is required.
• Adhere to federal guidelines on patient registration and reimbursement; serve as a resource for others.
• Take on various projects as requested by supervisor.

Job description

Ozarks Medical Center in West Plains, MO is seeking a Billing Compliance Specialist to perform insured account compliance checks for admitted patients and ensure accurate documentation for Medical Records review. You will verify diagnosis codes and procedures in the order checker, obtain necessary authorizations, and support compliant pre-certifications in line with payer requirements.

You will also review insurance coverage, determine primary payer when needed, and participate in special