Insurance Specialist (JR24-48852)

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This position 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.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school diploma or equivalent.
2. West Virginia state criminal background check required, and Federal, if applicable, for DHHR BMS regulated area.

PREFERRED QUALIFICATIONS:

EXPERIENCE:
1. Previous insurance authorization experience.

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.

1. Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
2. Follows up on accounts as indicated by system flags.
3. Contacts insurance company or employer to determine eligibility and benefits for requested services.
4. Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
5. Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
6. Performs medical necessity screening as required by third party payors.
7. Documents referrals/authorization/certification numbers in the EPIC system.
8. Initiates charge anticipation calculations.Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
9. 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.
10. Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
11. Communicates problems hindering workflow to management in a timely manner.
12. 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… For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
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 contractors legal duty to furnish information. 41 CFR 60-1.35(c)