Posted in Other 30+ days ago.
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Type: Full Time
Location: Morgantown, West Virginia
JOB TITLE & CODE:
Insurance Specialist (60253)
Various Outpatient Clinics
POSITION SUMMARY: Insurance Specialist is responsible for assuring all appointments and procedures are authorized. Insurance carriers are contacted to verify coverage and benefit limitations. Tests and procedures are pre-authorized and scheduled. Deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection. Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
High school graduate or equivalent.
Minimum typing speed of 25 works per minute
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department
Follows up on accounts as indicated by system flags
Contacts insurance company or employer to determine eligibility and benefits for requested services
Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution
Use work queues within the EPIC system for scheduling, transition of care, and billing edits
Performs medical necessity screening as required by third party payors
Documents referrals/authorization/certification numbers in the EPIC system
Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility
Maintains current knowledge of major payor payment provisions and regulations
Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed
Ability to accurately utilize applicable computer software and equipment for access processing
Demonstrates ability to follow established computer down time procedures.
Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
Follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to supervisor or manager)
Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.
Is polite and respectful when communicating with staff, physicians, patients and families. Approaches interpersonal relations in a positive manner.
Uses hospital communications systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards
Communicates problems hindering workflow to management in a timely manner.
Assesses all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.
PHYSICAL REQUIREMENTS: The physical demands described here 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.
Prolonged periods of sitting required
Extended periods on the telephone requiring clarity of hearing and speaking
Manual dexterity required to operate standard office equipment
Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Outpatient clinical environment
SKILLS AND ABILITIES:
Excellent oral and written communication skills
Basic knowledge of medical terminology preferred
Basic knowledge of ICD-10 and CPT coding preferred
Basic knowledge of third party payors preferred
Basic knowledge of business math preferred
General knowledge of time of service collection procedures preferred
Excellent customer service and telephone etiquette
Must have reading and comprehension ability
Date Reviewed/Revised: August 2017
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
* Please view Equal Employment Opportunity Posters provided by OFCCP here http://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm.
* The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)