Baptist Health

Insurance

• Verifying insurance eligibility and obtaining authorizations for office visits, diagnostic and procedural services.
• Works closely with Baptist Medical Group Representatives, all medical facilities, insurance companies, providers, patients and family members.
• Works daily reports from various systems to ensure the proper capture of all patients for verification/authorization.
• Communicates directly with the patients three (3) to five (5) days prior to arrival with information about co-pay, co-insurance and deductible amounts due at time of service (makes three (3) attempts to contact patient prior to visit) and provides patients with information regarding financial arrangements and/or financial assistance when needed.
• Provides patients and ordering physicians with information regarding needed authorization prior to patient’s arrival.
• Files and follows up on appeals to the insurance companies. Communicates appeal information to the providers and patients.

Insurance Follow Up Verifier – Ear, Nose, & Throat

Manager

• Reviews and negotiates contracts to ensure operational viability, and reviews and negotiates contracts to ensure legal viability (e.g. federal and state law, HIPAA, AHCA). Ensures contracts comply with various regulatory requirements and accrediting agencies. Remains abreast of contracts to be completed in order to facilitate execution within stated timeframes.
• Manages a network of matrixed relationships with customers, suppliers and leadership to ensure successful implementation and management of BHC’s contracts. Keeps contract owners apprised of contract status, maintains relationships with key leaders to facilitate review process, works to improve efficiencies and effectiveness of contract integrity process, and assists in education of leaders and peers regarding contract status.
• Conducts legal research and remains abreast of healthcare, compliance and contracting laws.
• Assists in preparation and analysis of requests for proposals (RFP), requests for information (RFI), and analyze group-purchasing organization’s (GPO) contract offerings.
• Provides analytical support for product standardization efforts. Reviews and edits documents to ensure accuracy, quality, and integrity.
• Acts as a liaison between Marketing and other departments in efforts to finalize documents for publishing.
• Provides administrative support to Document Control Specialist team member.
• Oversees and manages the Document Control team, providing day-to-day management of document control processes and communications within the department and broader organization.
• Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission.
• Maintains responsibility for department’s operational excellence; ensures department delivers quality services in accordance with applicable policies, procedures, and professional standards.
• Manages team members, which includes orientation, development and evaluation of team members, and monitoring the provision of delivering quality services. Participates in the recruiting, interviewing, and selecting of team members following policies, guidelines and applicable laws. Evaluates team member’s performance relative to job goals and requirements. Provides coaching to staff, recommends education programs, and ensures adherence to internal policies and standards.
• Maintains responsibility for the fiscal management of department and assures proper utilization of organization’s financial resources.
• Effectively communicates departmental, organization, and industry information to staff.
• Assists in other duties as assigned to support the operational needs of the department and organization.
• May be required to remain on campus immediately before, during, and after severe weather and/or disasters.

Insurance Follow Up Verifier – Ear, Nose, & Throat

Contracts and Documents Manager