Coverage Specialist

Title: Coverage Specialist

Location: Fountain Valley

Department: MCSS Patient Accounting

Status: Full-time

Shift: Days

Pay Range: $25.71/hr - $37.28/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork

Purpose Statement / Position Summary

The Patient Financial Services Coverage Specialist is responsible for adhering to HIPAA regulations while ensuring accurate insurance is assigned to a patient's coverage portfolio and subsequent encounters. The position is essential to Patient Financial Services accurately capturing, billing and recovering hospital revenue timely and efficiently.

Essential Functions and Responsibilities of the Job

1. Validate insurance coverage for all assigned patients to ensure service is covered under the patient's plan and regulatory guidelines.

2. Analyze Real Time Eligibility (RTE), payer portals, websites, etc., to extract eligibility and key coverage data elements.

3. Proactively interacts with insurance companies, government agencies and/or patients to obtain insurance information for correct reimbursement of accounts receivables.

4. Apply coordinating benefit guidelines including consumer rights while determining insurance coverage and filing order.

5. Uses individual, family and dependent benefit information to ensure accurate insurance is assigned to hospital encounters.

6. Adhere to all HIPAA regulations by accurately coding insurance in the billing system to ensure accurate and timely billing.

7. Determine out-of-pocket costs and generate patient estimates to foster a Simply Better patient experience.

8. Precisely document all applicable co-payments, co-insurance and deductibles.

9. Strong organization skills with the competence to work independently and prioritize responsibilities.

10. Innovative with the talent to multitask, analyze, problem solve with one-touch resolution and think critically in a fast-paced environment.

11. Knowledge of industry-specific terminology, billing and collections principles and best practices with complete understanding of relevant laws, rules and regulations.

12. Comfortable working remotely in a private and professional workspace with a fast, reliable internet connection.

13. This position offers you the opportunity to work from home (WFH) after all training has been completed. Once completed you will need to be available to come into the office for additional training, meetings etc., as needed.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out our MemorialCare Benefitsfor more information about our Benefits and Rewards.

Experience

Minimum 4 years of experience in an acute hospital business office setting, preferred.

EPIC Hospital Billing Resolute experience, preferred.

Proficient in Microsoft Suite Applications, preferred

Education

Bachelor's degree, preferred

Associate degree or medical field certificate, preferred

Business related courses, preferred

High School diploma, GED equivalent, preferred