Insurance Specialist (BHS)

MISSION, VALUES and SERVICE GOALS

MISSION: We deliver outstanding care, inspire health, and connect with heart.

VALUES: Trust. Respect. Integrity. Compassion.

SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

About the role

Reports and works under the direction of the Department Director/Manager/Supervisor. Reviews patient records using medical coding procedures. Verifies insurance eligibility and ensures the patients healthcare benefits cover the required procedures. Assists in educating patients regarding insurance. Coordinates daily administrative activities and patient support functions within the department. Ensures the appropriate and accurate documentation is maintained. Facilitates communication and serves as a resource to staff and patients as appropriate.

Responsibilities

• Answers the many questions phoned in regarding insurance problems.
• Delivers accurate documentation to Insurance companies.
• Works closely with Physicians and clinical staff to obtain prior authorizations for treatments, procedures and medications.
• Audits for correct billing/documentation.
• Communicates and educates physicians and staff associates on any documentation issues in a timely manner in order to correct errors or omissions in the medical record.
• Serves as point person for any insurance denials or claim errors by: Works closely with Patient Accounts to properly follow up on insurance company appeals and denials.
• Maintains online insurance portal knowledge and usage.
• Serves as an on-site Insurance Specialist resource to department associates and physicians.
• Serves as a liaison and works closely with Patient Accounts, Medical Records, and department associates.
• Assists the Director/Manager/Supervisor and Clinic Coordinator with updating and training staff on coding changes.
• Communicates via telephone and in writing with patients, employers, and third party payers.
• Verifies that the billing exported out of department matches charges that are uploaded into the hospital and physician billing systems.
• Completes other job related duties and projects as assigned.

Qualifications

Education and Experience: A health insurance specialists must have extensive knowledge of the latest alphanumeric codes used in medical billing, so post-secondary training is required. The knowledge, skills, and abilities as indicated above are normally acquired through the successful completion of an associate's degree majoring in medical billing, medical coding, health informatics, health information technology or a related healthcare field certification. A minimum of 1 to 2 years of department specific work experience and/or insurance prior authorization and verification of benefits is required.

Knowledge & Skills: The knowledge of medical terminology in regards to procedure and diagnosis codes, policies, legislation, equipment and professional disciplines. Demonstrated communications and interpersonal skills necessary to effectively interact with patients and guarantors. Knowledgeable in Medicare and Medicaid guidelines. Must be tactful in handling patient problems often of a highly personal and confidential nature. Must be able to maintain professionalism during frustrating interpersonal situations. Analytical skills are a must for health insurance specialists to check for any billing errors and make the necessary modifications. Detail-oriented with good organizational skills will help health insurance specialists file all essential insurance paperwork correctly. Health insurance specialists need the technical skills to work with electronic health records, coding software, email, and databases.

Benefits

Ability to adapt to change and close working conditions. Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needs. May need to travel to other Beacon locations. Ability to adjust communication skills to the level of the patient and ordering providers.

Physical Demands

Prolonged periods of sitting and/or standing in front of a computer monitor. Requires the physical ability and stamina to perform the essential functions of the position.