Viva USA, Inc

Collaborate with Provider Relations Manager, Verification of Benefits Manager and Revenue Cycle manager on payment analysis and providing feedback for new patient admissions and or continuation of care.. Three to Five (3-5) years experience in insurance benefit verification and/or collections and/or managed care contracting.. Knowledge of VA, Workers Comp, PA Appeals is a must. Nature of Work: Person will be doing Verification of Benefits in the Appeals process for prior authorization/denials/exceptions, etc.. Person MUST come with 1 year of experience and knowledge in Veteran Affairs, Worker Compensation, Medicaid, Medicare Advantage, PPO and Prior Authorization Appeals are all a MUST

customer service

Title: Customer Service - Onsite Description: Principle Responsibilities The following reflects management s definition of essential functions for this job, but does not restrict the tasks that may be assigned.Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.Responsible for direct communication and building relationship contacts with health plans to secure Single Case Agreements.Responsible for the management of all Single Case Agreements, including, tracking outcomes, identifying problem payers, negotiating rates (as needed), and securing required signatures.Oversees and ensures the accuracy of Single Case Agreements meets authorization and claims requirements.Collaborate with Provider Relations Manager, Verification of Benefits Manager and Revenue Cycle manager on payment analysis and providing feedback for new patient admissions and or continuation of care.Present feedback on outcomes and correspondence or lack of correspondence related to Single Case Agreements that present risk on reimbursement outcomes.Routinely evaluates Insurance Master, Plan Guidelines and non-contracted tools of current processes and make updates as needed based on Single Case Agreement outcomes.Acquires necessary medical records and documentation from customer charts to communicate via phone, fax or e-mail with other medical facilities, hospitals and insurance carriers.Follows all regulatory policies and procedures, privacy and security standards in accordance with government agencies to include HIPAA requirements.Performs other duties as assigned by superiors Required Qualifications High School Diploma or GED requiredThree to Five (3-5) years experience in insurance benefit verification and/or collections and/or managed care contracting.Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer serviceAbility to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practicesUnderstand the process for verification of benefits and collections as it relates to the policies and procedures for effective placement of customers and reimbursement.Complete Understanding of Medicare Rules and RegulationsAdvanced MS Office experience, with an emphasis on MS Excel desired Preferred Qualifications Associate s Degree is preferredKnowledge in Managed CareKnowledge in Contracting and Fee SchedulesStrong Computer/Software Skills Physical Requirements Must be able to work at a computer workstation for extended periods of timeNo lifting over 10 pounds required without assistance Years Experience: min. 1 yr. Knowledge of VA, Workers Comp, PA Appeals is a must Skills: understanding of Medicare rules and regulations; understanding of managed care as it relates to benefits and authorizations; advanced MS Office experience; strong verbal and written communication skills; Education: min. HS diploma or GED equivalent Duties: Contacts insurance companies to verify insurance benefits; initiates pre-authorization requests for new and ongoing services with insurance companies and performs follow up activities for an outcome; files Appeals for denied coverage to insurance companies as needed; maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance company; coordinates and communicates with other departments as needed to obtain necessary information to complete benefit verification, authorization, appeals and outcomes for services of care; provides customers with information that includes but is not limited to: updates on status of authorizations, developing & communicating patient financial responsibility estimates, and collecting co-pays, if applicable; applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes; performs other related duties as assigned. Notes: Hours: 8 to 4:30 pm or 8:30 to 5pm with two 15 min breaks and one half-hour lunch breakNature of Work: Person will be doing Verification of Benefits in the Appeals process for prior authorization/denials/exceptions, etc. Lots of paperwork and phone calls.Person MUST come with 1 year of experience and knowledge in Veteran Affairs, Worker Compensation, Medicaid, Medicare Advantage, PPO and Prior Authorization Appeals are all a MUSTTop skills to look for: ability to work in a fast paced environment, ability to be adaptable to change, attention to detail, good phone skills/communication skillsWill train on their system which is Patient Connect/Salesforce Associated topics: answer, call center, client, customer order, customer service representative, guest, help desk, representative, service call, telephone activation specialist

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