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Patient Financial Services, Insurance Verification Specialist - (Credit - Collections Clerk I)


Northridge, CA
Job Code:
  • Financial Services
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Job Details

Company Medtronic
Job Title Patient Financial Services, Insurance Verification Specialist - (Credit - Collections Clerk I)
JobId 34485
Location: Northridge, CA, 91325, USA

Patient Financial Services, Insurance Verification Specialist - (Credit - Collections Clerk I)


Northridge, California, United States

Requisition #:


Post Date:

Sep 27, 2017

As a key member of the Patient Financial Services (PFS) insurance verification team, responsible for all aspects of insurance eligibility, and benefit verification, including customer service, with the objective of minimizing controllable denials, and maximizing clean claim rate.

Following prescribed policies, and procedures, performs a variety of verification tasks, using standard healthcare guidelines. Obtains insurance coverage information from patient, and payor, utilizing all available tools, including medical documentation, and contract information to select the appropriate financial status classification (FSC). Obtains accurate benefit information to identify patient financial liability. Enters data into computer systems using defined resources and programs, and investigates questionable data, and recommends actions to resolve discrepancies.

Executes on established department objectives and assignments which affect the immediate operation, but that also have full revenue cycle, and ultimately company-wide financial impact.

A Day in the Life:

• Provide eligibility and insurance verification support to the Supply Management Team (SMT) and Pump Order Services (POS) teams by working assigned tasks within service level agreements.

• Utilize the system, and/or contact the patient to obtain basic policy, plan and group numbers for all insurance carriers on the patient’s account to confirm eligibility.

• Interact with insurance carriers/patients/websites to conduct comprehensive insurance benefit verifications for all insurance carriers with confirmed eligibility on the patient’s account.

o For all Medtronic products, determine the appropriate coverage category, i.e. DME, pharmacy, both or non-covered.

o Identify any medical policy requirements for coverage, i.e. pre-existing, lab requirements, office visits, blood glucose logs, etc.

o Obtain all necessary information to estimate patient out of pocket liability, i.e. deductible amount, deductible met, co-pay/co-insurance, coordination of benefits, and DME cap.

o Obtain referral / authorization requirements down to the HCPCS level, including dollar threshold and utilization limitations.

• Document insurance eligibility and benefits within the customer account, using appropriate note standardization and document management policies, to ensure accurate and timely billing for current and future customer orders.

• Collaborate with internal and external customers to assist our patients with questions on obtaining Medtronic products, therapy, troubleshooting, health insurance coverage concerns, transferring patients to the appropriate department as needed.

• Meets or exceeds key performance indicators measuring productivity, quality, and service level as defined by Senior Management.

• Actively participates in team initiatives and in team status meetings.

• Additional team activities, projects, and work flow as assigned.

• Service Excellence:

o Works to identify ways to initiate processes that work towards enhanced revenue cycle outcomes, and improving service levels to both internal and external customers.

o Actively participates in process and service improvement activities

o Encourages and supports staff members in the pursuit of service excellence

Must Haves:

• High School Diploma or GED

• 1+ year experience in insurance verification (including benefits, eligibility, and/or authorization) OR 1+ year experience in billing/collections experience in a medical group, healthcare company, or hospital setting OR 2+ years’ experience in Medtronic POS Inside Sales role and/or SMT role.

• Experience with various insurance plans offered by both government and commercial insurances (i.e. PPO, HMO, EPO, POS, Medicare, Medicaid, HRA’s) and coordination of healthcare benefits, including requirements for referral, authorization, and/or pre-determination.

• Experience with MS Office (Word, Excel, Outlook)

Nice to Have:

• Minimum 4 months experience working in a Medtronic department with revenue cycle responsibilities.

• Experience understanding medical policy information, and utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms.

• Experience with medical billing and collections terminology – CPT, HCPCS and/or ICD-9 coding.

• Experience with HIPAA guidelines and healthcare compliance.

• Good customer service skills with ability to interact with both internal and external customers, i.e. patients, insurance payors, doctors, internal departments, and handle in a professional manner with customer-friendly focus and attention to detail in resolving issues.

• Proficiency in navigating multiple screens and programs at the same time in order to facilitate problem solving, and other activities that require multi-tasking.

• Ability to maintain composure, and to follow instructions and protocols when dealing with unfamiliar or unusual payor/customer issues.

• Demonstrated ability to present information in a clear, concise, and grammatically correct manner both verbally and in writing.

• Demonstrated collaboration skills (including active listening skills, presentation skills) and proven ability to work effectively in a diverse, inclusive organization and environment.

• Demonstrated ability to accept and carry out oral and written instructions accurately.

• Demonstrated ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment.

• Ability to prepare forms, spreadsheets, and graphs.

• Experience in a payor or medical provider community that deals with all aspects of the revenue cycle.

• Experience in a large corporate (even matrixed) environment.

• Previous work experience with GE Centricity.

• Previous experience in receiving and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities.

Physical Requirements:

•The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to interact with a computer, and communicate with peers and co-workers.

• Ability to sit, wear a headset, and work on the computer for extended periods of time.

• Ability to lift 5lb ream of paper.

• Ability and willingness to work flexible hours and varying daytime shifts, including overtime.


Together, we can change healthcare worldwide. At Medtronic, we push the limits of what technology can do to help alleviate pain, restore health and extend life. We challenge ourselves and each other to make tomorrow better than yesterday. It is what makes this an exciting and rewarding place to be.

We can accelerate and advance our ability to create meaningful innovations – but we will only succeed with the right people on our team. Let’s work together to address universal healthcare needs and improve patients’ lives. Help us shape the future.


It is the policy of Medtronic to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Medtronic will provide reasonable accommodations for qualified individuals with disabilities.

This employer participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here:


The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position

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