What are the responsibilities and job description for the Eligibility Insurance Specialist position at Conifer Health Solutions?
Job Summary
JOB SUMMARY
Working Location: Piedmont Medical Center (Fort Mill)
Shift Information: Monday-Friday 8a-4:30p
The Insurance Specialist is tasked with identifying candidates for the Health Insurance Premium Payment (HIPP) program. In addition to assisting with identifying the potential candidates, other responsibilities will include assistance with enrollment, working closely with family and the agency through the enrollment process; identify all sources for payment, documenting accounting system including progress notes and all required activities to ensure accurate reporting and following the case through the approval process. This individual will work closely with the EES onsite teams to coordinate the patient’s application process
Essential Duties And Responsibilities
Include the following. Others may be assigned.
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Knowledge, Skills, Abilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education / Experience
Include minimum education, technical training, and/or experience preferred to perform the job.
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.
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.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
2603017245
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
JOB SUMMARY
Working Location: Piedmont Medical Center (Fort Mill)
Shift Information: Monday-Friday 8a-4:30p
The Insurance Specialist is tasked with identifying candidates for the Health Insurance Premium Payment (HIPP) program. In addition to assisting with identifying the potential candidates, other responsibilities will include assistance with enrollment, working closely with family and the agency through the enrollment process; identify all sources for payment, documenting accounting system including progress notes and all required activities to ensure accurate reporting and following the case through the approval process. This individual will work closely with the EES onsite teams to coordinate the patient’s application process
Essential Duties And Responsibilities
Include the following. Others may be assigned.
- Performs an in-depth analysis of all inventory identified as eligible. The analysis includes, but not limited to review of patient’s demographics, payor data review, understanding payor methodology, commercial vs. government payor structures. Working knowledge of chronic illnesses, researching and understanding of diagnosis and patient’s prognosis, reviewing medical records as necessary to determine eligibility
- Develop a working relationship with patient and/or family through application process for completion and follow-through of each case. Working closely with State agencies to facilitate case approval, filing appeals as necessary. Contacting patient’s employer HR department and/or insurance company to gain knowledge on insurance fee structure
- Secures all required forms and data for the program, develops working relationship with MECS Director, Social Workers and Case Management, PA Directors as needed to communicate progress on the application status as well challenges with the case and how it may affect the payor outcome. Understanding of revenue reclassification
- Follows up on all assigned inventory timely according to documentation and follow-up guidelines. Documents thoroughly, applies all necessary codes to ensure accounts are captured correctly through our reporting. Once approval is obtained ensures coordination of benefits are correctly documented and verified
- Works closely with management team to continue the development of the program
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Knowledge, Skills, Abilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Working familiarity with the rules and regulations pertaining to Federal, State and County programs
- P/C systems literate including Windows, and Micorsoft Outlook, Excel and Word programs
- Ability to work independently
- Excellent oral and written communication skills, as well as the clear understanding of the English language
- Detail oriented, with strengths in dealing with multiple facilites, Supervisors, and Hospital platforms
- Ability to prioritize and manage multiple tasks with efficiency
- Valid Drivers License and auto insurance
Education / Experience
Include minimum education, technical training, and/or experience preferred to perform the job.
- High School Diploma or equivalent
- Minimum 2 years of work experience in the medical field
- Knowledge of Medical terminology
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.
- Must be able to work in sitting position, use computer and answer telephone
- Ability to travel
- Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
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.
- Office or Hospital Work Environment
- Approximately 10% travel may be required
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
2603017245
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.