Insurance Specialist financially secures accounts within established timeframes. Ensures that all notifications to payers are completed, authorizations obtained, verifies coverage and benefits, reviews and corrects each pre-registration for accuracy of financial information, and appropriately documents information in the system account notes. Maintains operational knowledge of all insurance payers and requirements necessary to ensure maximum and timely reimbursement. Responsible for participating in the efficient, complete and timely patient registration process that models the customer service philosophy of Community Hospital and Northwest Surgical Hospital.

Essential Functions:

Community Hospital Only

• Notify Case Management daily of all inpatient and observation patient admissions to ensure communication to insurance companies of patient’s status.

All Facilities

• Accurately obtain via fax, telephone or personal interview, the required financial and insurance information from the patient, patient’s representative, scheduling or physician’s office.
• Verify and obtain insurance coverage and benefits via insurance company website, insurance eligibility programs or by telephone for all patients registered for services for all payer types. Consistently strives to stay a minimum of three (3) business days in advance of patients arrival.
• Perform notifications and obtain pre-authorizations and/or per-certifications for timely and accurate reimbursement. Determine appropriate financial class and accurately enter the data into the system.
• Communicate insurance coverage details to patients and inform the patient/guarantor prior to service date regarding payment expectations related to co-payments, co-insurance, and/or deductible amounts. Establish payment arrangements as appropriate according to established guidelines.
• Notify patients of any required and expected co-pay’s, deductibles or co-insurance payments prior to their arrival.
• Attempt to collect patient payments during initial phone contact in order to alleviate the amount of effort and time required on the day of service.
• Log cash collections, generate receipts and maintain a balanced cash drawer at all times. Post payments to patient’s account as required.
• Document in the patients account notes any information that will assist the business office in their efforts to understand the issues that may impact efficient billing, questions about the status of the claim or other follow-up.
• Provide assistance to patients when they present to the facility in person with questions regarding billing or open accounts.
• Inform Department Director or Team Lead of potential problem accounts or additional requirements for reimbursement to receive direction on how to resolve situations.
• Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.
• Consistently respond to all incoming calls within the third ring.
• Meet established quality and productivity standards for self and for the team.
• Anticipate and adapt to change (e.g., hospital policy changes, operational/procedures, insurance changes) in a positive manner.
• Foster and reinforce team-based results.
• Adhere to time and attendance standards as outlined in the Human Resource Policy manual. Provide proper notification of absence or tardiness within established departmental time frames.
• Ensure patient confidentiality adhering to HIPAA guidelines.
• Demonstrate the knowledge, skills and abilities (competencies) to perform the duties outlined above annually in the form of a test or as evidenced by daily quality review and direct observation of the Team Lead and/or the Department Director.
• Track and monitor productivity as requested.
• Keep Department Director apprised of any delays in the registration process.
• Remain current on scheduling, registration, insurance verification, and other patient registration processes in order to cover in the absence of other team members.
• Perform other duties as assigned.

Accountability:

• Reports to: Director or Manager, Team Leader, Patient Access
• Supervises: None

Q ualifications:

• High School graduate or equivalent required; 2 years college preferred.
• Experience in patient registration, verification and authorization in a medical center or comparable required.
• Working knowledge of managed care, Medicare, worker’s compensation, indemnity and other third party payers required.
• Working knowledge of governmental regulations and other reimbursement criteria required.
• Ability to accurately type 40 WPM, complete forms, simple correspondence and enter data.
• Excellent verbal and written communication as well as interpersonal skills required.
• Demonstrated ability to handle multiple tasks with short time-lines, prioritize and organize work, and complete assignments in a timely and accurate manner.
• Exceptional ability to interact and communicate effectively, tactfully, and diplomatically with patients, families, medical staff, co-workers, employers and insurance company representatives.
• Must have a pleasant disposition, positive attitude and possess the ability to maintain a cordial and professional approach during periods of stress.
• Skill in using office equipment: basic computer skills, photocopier, telephone, fax machine, and calculator.
• Demonstrated ability to think and act decisively in a timely manner.
Ability to maintain operational knowledge of all insurance requirements necessary to achieve optimal reimbursement.

Required Physical Demands:

Strength (Lift, Carry, Push, Pull): Sedentary; exerting up to 20 pounds of force occasionally

Standing/Walking: Occasionally; activity exists up to 1/3 of the time

Keyboard/Dexterity: Constantly; activity exists 2/3 or more of the time

Talking (Must be able to effectively communicate verbally): Yes

Seeing: Yes

Hearing: Yes

Color Acuity: No

Environmental Conditions:

High exposure to hazardous risks including potential for exposure to infections and communicable diseases, blood and body fluids, electrical equipment and chemicals. Must follow standard precautions. Heavy work volume and high degree of accuracy required. Ability to work in a fast-paced environment with frequent interruptions. May be required to work weekends or flex schedules. Travel may be required. Exposed to weather conditions during travel.

Q ualifications:

• High School graduate or equivalent required; 2 years college preferred.
• Experience in patient registration, verification and authorization in a medical center or comparable required.
• Working knowledge of managed care, Medicare, worker’s compensation, indemnity and other third party payers required.
• Working knowledge of governmental regulations and other reimbursement criteria required.
• Ability to accurately type 40 WPM, complete forms, simple correspondence and enter data.
• Excellent verbal and written communication as well as interpersonal skills required.
• Demonstrated ability to handle multiple tasks with short time-lines, prioritize and organize work, and complete assignments in a timely and accurate manner.
• Exceptional ability to interact and communicate effectively, tactfully, and diplomatically with patients, families, medical staff, co-workers, employers and insurance company representatives.
• Must have a pleasant disposition, positive attitude and possess the ability to maintain a cordial and professional approach during periods of stress.
• Skill in using office equipment: basic computer skills, photocopier, telephone, fax machine, and calculator.
• Demonstrated ability to think and act decisively in a timely manner.
• Ability to maintain operational knowledge of all insurance requirements necessary to achieve optimal reimbursement.

• Benefits
• • Medical
  • • Minimal out-of-pocket expenses for services provided by the company.
    • Standard PPO benefits for 2 nd tier providers/facilities.
    • Generous prescription plan available with enrollment on the medical plan.
  • Dental
  • • Two in-network options when choosing a dentist for maximum savings and lower out-of-pocket expenses.
  • Vision
  • • The largest national network of private-practice doctors making it easy to find the in-network doctor who is right for you.
  • Section 125 Plan offered to include pre-tax premiums for Medical, Dental and Vision as well as flexible spending for unreimbursed out of pocket eligible medical expenses and dependent care.
  • Company Paid Life Insurance policy for employee with option to purchase additional coverage for employee, spouse and/or dependents.
  • Company Paid Long Term Disability which goes into effect after an absence due to medical disability for more than 120 days.
  • Short Term Disability available for purchase to bridge the gap between being out and when long term disability kicks in if applicable and allows employee to avoid exhaustion of paid time off.
  • Accident Insurance and Critical Illness coverage available for purchase on employee, spouse and/or dependents.
  • 401(k) with a generous match.
  • Generous paid time off accrual program.
  • 7 paid holidays.
• Current Employees:
• • Please note, if you are applying for this position you must communicate to your direct supervisor regarding your interest in this position.