Patient Access & Insurance Verification Specialist

Jupiter Medical Center Physicians Group, Inc.; United States; On-site; USD 42,000 - 65,000; Full time

Job summary

Jupiter Medical Center seeks a Patient Access Specialist to deliver a dynamic customer experience, gathering demographics, insurance details, and medical information to ensure accurate registration.

You will perform insurance verification, determine medical necessity, identify patient financial responsibilities, and coordinate with internal teams to secure proper reimbursement while adhering to CMS guidelines.

Qualifications

• BLS certification through the American Heart Association.
• Experience using EMR systems, performing insurance verification, eligibility checks and electronic billing.
• Billing and coding certification preferred.
• Strong knowledge of health insurance plans and CPT & ICD-10 coding.
• Ability to read CMS & NCCN guidelines; maintain confidentiality.
• Exceptional written and verbal communication; strong organization.
• Proficient in Microsoft Office.
• Ability to set priorities and multi-task.
• Strong interpersonal skills.

Responsibilities

• Perform insurance verification, data collection and documentation.
• Determine medical necessity for services based on established medical criteria.
• Identify patient financial responsibilities and collect applicable monies.
• Act as liaison to internal and external customers to facilitate access to hospital services.
• Secures all necessary documentation to register the patient's visit.
• Reviews all documentation to ensure coding by provider is supported and accurate.
• Applies all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers.
• Assist manager in educating physicians and staff in requirements of documentation for proper reimbursement.
• Assists in conducting internal audits of patient charges and corresponding documentation, reports and tracks on a monthly basis.
• Submit claims and works rejections for claims submission, daily.
• Checks for data errors and uses them as examples for educating team members.
• Determines problems that resulted in a rejected claim, resolve, advises on procedural changes to implement and prevent further such rejects.
• Resubmits/refiles, print records as needed to appeal rejected claims, as is necessary.
• Check coding and post charges.
• Adhere to contractual requirements of Medicare, Medicaid, and managed care plans.
• Scrubs and reviews charges before claims are submitted.
• Reviews surgical claims and post-op visits to ensure we capture a full reimbursement.
• Run daily update and insurance exception reports.
• Review and correct, re-scrub rejected claims.
• Performs other duties as assigned.

Skills

Communication skills

Customer service

Time management

Attention to detail

Interpersonal skills

HIPAA compliance

Microsoft Office

Medical terminology

Insurance knowledge

Education

High School Diploma

BLS certification (AHA)

CPT/ICD-10 coding knowledge

Billing and Coding Certification

Health insurance knowledge

Tools

EMR systems

Electronic billing systems

Insurance verification systems

Job description

Jupiter Medical Center seeks a Patient Access Specialist to deliver a dynamic customer experience, gathering demographics, insurance details, and medical information to ensure accurate registration.

You will perform insurance verification, determine medical necessity, identify patient financial responsibilities, and coordinate with internal teams to secure proper reimbursement while adhering to CMS guidelines.