Benefits Specialist

Summary

The Benefit Verification Specialist I plays a key role in ensuring that front-end teams coordinating patient care have a clear understanding of each patient’s behavioral health insurance benefits prior to treatment. As the first step in the patient’s financial experience, this position verifies behavioral health benefits, determines patient financial responsibility, and communicates coverage information effectively to internal teams to support timely and accurate admissions and claims. The specialist is also responsible for identifying and correcting demographic errors daily, ensuring accuracy and compliance for all admitted patients.

Job Duties & Responsibilities

Verify behavioral health insurance benefits for patients and potential patients

• Spend significant time on the phone and online with insurance and managed care companies to confirm behavioral health coverage, limitations, referrals and authorization requirements.
• Use online payer portals as well as facility resources, managed care grids to accurately receive, interpret, and document benefit information.as required
• Accurately document quote of benefit details in Cerner, using correct dropdown selections, updating required fields, and assigning items to follow-up worklists as appropriate

Maintain high-level multitasking by actively working in multiple systems at once, verifying benefits, completing portal checks, correcting registration or demographic errors, and documenting results in Cerner, all while navigating multiple monitors and continuing productive work during insurance hold times. Audit demographic, insurance and financial data daily to ensure accuracy for encounters.

• Communicate with admissions, care coordination and utilization review teams to ensure accuracy of accounts Identify potential coverage issues and escalate appropriately to avoid admission delays.
• Knowledge of Rogers programs and the facility’s admission, insurance authorization, and billing processes.

Support departmental goals and team development

• Participate in daily peer audits and huddles, providing and receiving constructive feedback in a professional manner.
• Maintain up-to-date knowledge of behavioral health payer policies, authorization requirements, and facility programs.
• Support patients and internal teams by addressing benefit-related questions promptly and accurately.
• Contribute to training efforts, uphold department policies and procedures, and demonstrate punctuality, professionalism, and teamwork.

Apply good practice principles to job duties.

• Use good communication skills and tact to deal effectively with third-party carrier representatives, and all other team members internally and externally.
• Use common sense in situations and respond appropriately in all communication modes (body language, verbal) to everyone, regardless of his/her/their behavior.
• Maintain a calm attitude and create a conducive atmosphere in difficult situations.
• Work cooperatively and supportively with all
• Remain courteous and respectful to others during work interactions and be willing to work out problems on a one-on-one basis.
• Complete assignments and documentation on time.
• Take responsibility for and manage day-to-day problems, including completion of all documents.

Complete other duties as assigned by the supervisor of Benefit Verification team

Promote department goals and the Mission of Rogers Behavioral Health.

• Communicate goals to fellow staff members.
• Demonstrate measurable goal achievement.
• Maintain department policies and procedures.
• Include requirements and guidelines from external agencies (State of Wisconsin, Joint Commission).

Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.

• Demonstrate acceptance and training of student interns in the department, as directed.

Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations.

• Involve self in the learning and application of standards relevant to Admission Services.

Participate in in-services, seminars, and other meetings to increase involvement and awareness of regulations.

• Involve self in the education of other disciplines regarding Admission Services’ regulations.

Participate in Rogers committees, Rogers Improvement System (RIS) team meetings and team projects, as directed.

• Demonstrate punctuality and preparedness.
• Demonstrate effective communication skills and good organizational skills.
• Contribute in a positive, solution-focused manner.

Demonstrate willingness to complete tasks/responsibilities related to projects (i.e., audits, tracking data, etc.).

Conduct self in a professional manner.

• Demonstrate organizational skills that promote timely response to all inquiries and to task completion.
• Communicate with all individuals in a positive and professional manner.
• Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution.
• Communicate concerns and provide solutions for same.
• Attend outside seminars to promote professional growth.

Demonstrate a positive and professional attitude toward parties outside Rogers (patient families, visitors, vendors, etc.).

Comply with the Hospital’s policies and procedures, including Human Resources, Infection Control and Employee Health policies and programs. Project a professional image by wearing appropriate, professional attire.

Physical/Mental Demands:

• Ability to be flexible with work assignments, including schedule changes, caseload volume changes, changes in required documentation, program additions, and changes in policy and procedure.
• Sedentary position
• Ability to work effectively with professional staff, and Hospital staff members.
• Ability to exercise good judgment in determining the correct course of action in admission procedures and to utilize independent thinking.
• Ability to maintain a cooperative, tactful, warm, courteous, and helpful attitude toward, professional staff, and Hospital personnel at all times.
• Dependability, flexibility, and efficiency, possessing a positive attitude toward work at Rogers Behavioral Health.
• Computer skills required, including navigating multiple monitors, payer portals, EHR systems (Cerner preferred), Microsoft Office (Outlook, Word, Excel), and real-time documentation tools.
• High accuracy and attention to detail in data entry, documentation, and interpreting patient financial responsibility (deductibles, copays, coinsurance).
• Strong communication and problem-solving skills, including professional phone etiquette with payers, clear written documentation, time-management, and critical thinking.
• Commitment to confidentiality and HIPAA compliance while handling sensitive patient and insurance information.
• Verbal and hearing ability to interact with third-party payors and employees
• Numerical ability to maintain records and operate a computer.
• Ability to read and communicate through written, verbal and auditory skills.
• Physical and mental ability to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical.

Education Knowledge Requirements

• High school diploma required.
• Minimum 1 year of experience in healthcare, insurance, patient access, billing, revenue cycle, or a related administrative role preferred
• Experience with insurance verification, managed care plans, or behavioral health benefits strongly preferred

With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:

• Health, dental, and vision insurance coverage for you and your family
• 401(k) retirement plan
• Employee share program
• Life/disability insurance
• Flex spending accounts
• Tuition reimbursement
• Health and wellness program
• Employee assistance program (EAP)

Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)