Payer Verification Specialist

Payer Verification Specialist

Company Name: Limitlessli (www.limitlessli.com)

Limitlessli is a staffing company that recruits, hires, and manages long-term remote staff for growing businesses in the USA.

Client: A US DME company is looking for candidates with experience as a Payer Verification Specialist for DMEs.

Objective: To verify patient-specific benefits and ensure precise documents are submitted per payer.

Location: Remote (permanent work from home)

Type of Work: Full time

Work Hours: Mon - Fri, 9:00 AM - 6:00 PM, Eastern Standard Time (UTC)

Roles and Responsibilities:

By analyzing patient and facility information, the Payer Verification Specialist is primarily responsible for determining the correct payer to be billed for the services given.

• ● Review nursing home census to determine coverage for ancillary providers, and verify coverage for Medicare Part B and other insurances.
• ● Determine which insurance a patient has by analyzing the facility information and patients’ payer. This is then translated into which payer the DME company will actually bill
• ● Work with nursing home staff in ensuring all residents have appropriate payer (i.e private funds, private HMOs and/or government funded HMOs).
• ● Review daily census, create new residents' profile, monitor status/payer changes accordingly and ensure all discharged residents have no payer issues.
• ● Review New Resident Information (NRI) and ensure admissions department noted the correct payer source, verify resident's HMO benefits and eligibility and request status/payer change when necessary.
• ● Verify insurance coverage, benefits, and eligibility of each patient
• ● Review patients’ background, scope, and health history
• ● Review HMO Authorizations/HMO Logs to ensure all residents' stay are authorized by their respective insurance plans.
• ● Conduct weekly meeting with nursing home coordinators to review residents' payer sources, confirm discharge plans, discuss HMO/payment issues

Job Requirements:

• ● Experience in all nursing home payers, including Medicare, Medicaid, and HMO, strongly preferred.
• ● Knowledge of all US insurances covering Skilled Nursing Facility (SNF) or Nursing home patients
• ● At least 2 years of previous medical billing experience
• ● Experience working in a fast-paced environment
• ● Preferable to have experience working for an SNF either physically or remotely
• ● Detail-oriented
• ● Strong analytical skills

Working with Limitlessli:

• ● Remote work – home-based
• ● Environment must be quiet and professional

Salary Range: $850 - $900 / month

Start date: Can start ASAP

Tools needed: You MUST have your own laptop/desktop computer, a noise cancellation headset, second monitor, stable internet, and backup internet connection

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Last updated on Jul 7, 2022