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This position is also responsible for verifying patient insurance, confirming benefits eligibility, performing pre-authorization, pre-certification, and/or notification as required by third party providers.
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The FSS is responsible for pre-registration, insurance verification, communicating and helping secure the patient and insurance financial responsibilities prior to services.
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Conducts Pre-Registration tasks for specified inpatients and outpatients prior to their date of service including: collects demographic, financial, and clinical information necessary for financial clearance of scheduled patients; obtains missing insurance information via patient’s family or physician offices; and completes insurance verification using online electronic verification system or contacting payor directly.
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Experience Requirements Experience with third party payer billing regulations, reimbursement requirements, precertification, insurance eligibility verification, and/or utilization management is preferred.
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Accurately completes or assures completion of registration process and facilitates revenue enhancement through insurance verification, pre-authorization, verification of medical necessity and follow up of denials.
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Regulatory Compliance: Stay updated on relevant laws, regulations, and industry best practices related to third-party risk management. Knowledge of and experience with third-party risk management governance, policies, and organizational structures.
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Resolves all outstanding Alerts on pending appointments within 48 hours of the scheduled appointment to minimally include: Missing Referral Missing Pre-certification/Authorization Self Pay Accounts Eligibility Verification Missing Demographic/Insurance Information.
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Perform insurance eligibility verification utilizing various methods including portals and phone calls to confirm insurance coverage and eligibility of products. The Referral Specialist is responsible for the pre-authorization functionality.
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Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit Summary:Patient Access Insurance Verification Specialist is responsible for ensuring that patient health care covers required procedures.
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Must partner with regulatory agencies and firms such as FDA, ODA, USDA/Organic, and Kosher for third party auditors. The Food Safety Quality Manager is responsible for all Quality and Food Safety programs such as Kosher, Organic, Pest control, Sanitation verification, Environmental monitoring, Allergen control, foreign material control etc.
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Overview The Manager, Third Party Risk Management will be responsible for establishing, implementing, and or executing GRC Programs that are designed to effectively assess the Governance, Risk, and Compliance of Select Medical and its third parties including associated security policies, standards and guidelines related to all information systems.
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Responsible for securing patient data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre-certification, authorization and third party claims management.
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Verifies third party insurance coverage from daily admissions and scheduling databases; including contacting ordering physician’s office for missing insurance and procedure information and updates appropriate software systems.
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Minimum 7 years of knowledge of Third-Party Risk Management methodologies and regulatory guidance and or risk management at a fintech organization. Technology Skills:Certified in third party risk or other risk domains (CRVPM, CTPRA, CERP, CRISC)Project Management Professional (PMP), Certified Information Systems Auditor (CISA) or Certified Information Systems Security Professional (CISSP) or relevant IT certifications and credentials a plus.
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The successful candidate will play a critical role in enhancing and executing the bank's third-party risk management framework in accordance with industry best practices and regulatory requirements set forth by the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), and the Federal Deposit Insurance Corporation (FDIC.
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pre registration insurance verification third party jobs Company: Parkland Health Hospital System
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