Job Details

Newport News, Virginia

Overview
Responsible for verifying insurance eligibility and benefits, obtaining authorizations and providing patient estimates. Researches, follows-up and resolves open and pending authorizations in a timely manner. Monitors work queues, managing workload and completing accounts effectively.

What you will do

• Obtains, validates and updates insurance information in the database, verifying eligibility and benefits. Utilizes effective and professional communication with patients, physicians' offices, and staff.
• Calculates and provides patient estimates and financial obligations. Ensures collection and/or notification of payment due for services to be rendered. Provides information and resources for patients regarding RHS financial assistance and self-pay processes.
• Verifies and/or obtains the necessary referral, authorization, or pre-certification prior to services being provided as required by payer.
• Researches and obtains missing information from provider practices, providing timely notification of issues, denials, and/or need for peer to peer.
• Monitors work queues, managing workload and completing accounts in a timely manner; follows current department workflows, staying up to date on changes.
• Utilizes Riverside Care Difference principles in all interactions and maintains strict confidentiality in all matters relating to PHI.
• Identifies issues and trends related to pending/denied authorizations, escalating to team lead and/or manager.
• Participates in continuing education and other learning experiences, sharing gained knowledge with team.
• Navigates online portals and systems to determine authorization requirements; catalogs and tracks authorization requests.

Qualifications

Education

• High School Diploma or GED, (Required)

Experience

• 1 year Revenue Cycle experience (Required)

Licenses and Certifications

• Certified Healthcare Access Associate (CHAA) - National Association of Healthcare Access Management (NAHAM) (Preferred)

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