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Verification Specialist

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Job ID: 154498
Category: Clerical/Administrative
Work Type: FT
Location: Plainsboro, NJ, United States
Work Schedule: FT

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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

  • Under supervision from the Director and/or the Clinical Manager of Admissions provide insurance verification and coordination for all commercial, Medicaid and Medicare cases across programs to facilitate patient access to clinical services in the Princeton House system.

Responsibilities:

  • Possesses significant knowledge of all types in-network and out-of-network health insurance, managed care companies, benefits and policies for commercial, Medicare and Medicaid populations Possess significant knowledge of various Union related benefits Obtain insurance information via multiple systems, telephonic or electronic Contact insurance companies to verify patients’ mental health and substance abuse benefits for both commercial, Medicare, and Medicaid insurance plans across continuum Perform independently with the knowledge of insurance verification, policy plans and benefits in accordance with PHBH policies and procedures for use across continuum. Perform independently with contracting department notifications to coordinate proper contractual information is relayed regarding patients co-insurance Possess significant knowledge around contracts with payers and the need to facilitate single case agreements to ensure accurate and timely patient coverage and reimbursement Communicates with admissions team, local site and UM on all benefit related problems or alerts Continues to update knowledge and skills to maintain compliance with all insurance regulations and requirements Ability to develop a good working relationship with managed care organizations, and provide excellent customer service Ability to be proactive, demonstrate strong negotiation skills/patient advocacy when interacting with all managed care organizations Contact insurance companies to obtain evaluation authorization for patients’ mental health and substance abuse benefits to ensure proper payment Timely re-verify all commercial, Medicare and Medicaid policies within PHBH policy standards to ensure proper patient coverage and payment Maintain and update information in the SQL database to support benefit sheets for use at the local sites. Inform and support patients of their insurance benefits and or financial obligation to treatment in accordance with PHBH policies and accuracy standards. Ensures that all insurance information regarding urine drug screen testing is documented to the outpatient site appropriately to ensure payment.


    Education or Equivalent Experience: 

    HS/GED Required 

    2-4 years of related experience required 

    5-8 years of experience preferred 

      We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

      Live Your Life's Work

      We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

         Current UPHS employees must apply HERE
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