Insurance Specialist

Job Location

Position Type

Travel Percentage

Job Shift

Job Category

Location: Madison

Full-time | 1.0 FTE ( 40 hours/week) | Day Shift | Monday-Friday | 8a-4:30p

Option to work hybrid remote schedule

Make a lasting impact with Agrace

Join Agrace, a nationally recognized nonprofit leader in hospice and palliative care. If you are looking for a role that helps support meaningful, patient-centered care, this is your opportunity to make a difference!

How You’ll Make a Difference (Essential Functions)

The Insurance Specialist is responsible for assuring all new patient referrals to Agrace, either hospice or palliative care, have the proper insurance provider identified and entered into the Electronic Health System, that benefit coverages have been confirmed, and that required authorizations have been obtained. The Insurance Specialist is also responsible for obtaining the proper authorizations for current patients with changes in level of care to assure proper reimbursement is received, patients and families are provided accurate coverage information, and positive relationships are maintained with insurance partners.

Key Responsibilities

Provides insurance related customer service for referrals to Agrace programs

• Process requests for insurance verification from enrollment coordinators.
• Determine coverage by reviewing insurance information in electronic health records (EHR), Medicare and Medicaid portals, other payer portals (Dean, Quartz, Availity, etc.), Ability Clearinghouse and direct contact with patients and families.
• Obtain primary and secondary benefit information from identified commercial insurer specific to Agrace services including “in-network” vs. “out-of-network” coverage.
• Obtain authorizations for hospice and palliative care services.
• Document coverage information and authorizations in the EHR.
• Provide requested clinical information to insurers to obtain coverage authorizations.
• Respond to requests to admission staff in the field to obtain or clarify insurance benefit information.
• Obtain authorizations from commercial insurers for direct admissions to Agrace Inpatient Unit and subsequent authorizations.
• Maintain contact information and relationships information with insurance case managers.

Provide continued insurance support for existing patients

• Work with home teams and receive information on changes in patient level of care, contacting commercial insurers for authorizations.
• Provide clinical information as requested by insurers to support changes in care level and reimbursement.
• Manage automated EHR work queues to capture insurance discrepancies and expired authorizations.
• Notify insurers of other changes, such as discharges, revocations, and trips out of service area.

Other Duties

• Provide support to Admissions staff.
• Train new employees on benefit information, uses, and work flow related to insurance.
• Participate in internal work groups, meetings and committees relative to position responsibilities.

You Bring (Qualifications)

• High school diploma or GED or equivalent combination of education and work experience
• 3 – 5 years’ customer service in a healthcare setting with prior insurance experience
• Ability to develop, maintain, and apply knowledge of hospice and end of lie process
• Knowledge and understanding of health insurance terminology and plans – including HMOs, PPOs, Managed Care Providers and Veterans Benefits.
• Ability to multitask and thrive in a fast-paced environment
• Ability to maintain professional boundaries with patients, families and co-workers
• Ability to work effectively and cooperatively with others
• Ability to lead conversations and resolve conflicts
• Competence in culture/ethnicity, gender, race, age, and educational background diversity
• Beginning Microsoft Office Suite Skills
• Experience with electronic health records (EHR); Epic preferred
• Ability to communicate effectively verbally and in writing
• Ability to be flexible in time and task to meet organizational needs
• Ability to maintain confidentiality about patients, families, caregivers, staff, donors, and organization intellectual property.
• Ability to use proper body mechanics and standard precautions

Benefits

• Competitive pay with free parking
• Health, dental, and vision insurance for employees who are hired for 28 hours per week (.7 FTE )
• Retirement plans with employer matching
• Generous Paid Time Off (PTO) and holiday paid time off
• Comprehensive onboarding, mentorship, and career development

About Agrace

For more than 45 years, Agrace has been an innovator and leader in both caring for patients and their families, and in educating others about death, dying and grief. We are the largest hospice provider in Wisconsin. Well known for end-of-life care, Agrace also serves people across southern Wisconsin who are aging, seriously ill or grieving.

At Agrace we are strengthened by the unique experiences, cultures and traditions of our staff, patients and clients.

Together, we pursue a vision in which every Agrace staff member is treated fairly, and every patient and client experiences the respectful, individualized care they need and deserve.

We foster a culture of belonging that celebrates people’s uniqueness and leads to meaningful, empathetic connections.

Agrace Health Inc. is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.