Insurance Specialist -Temp

Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front-end collection. Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal (if applicable), as required for regulated areas.
• Previous insurance authorization experience (preferred).

Responsibilities

• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Follows up with the patient, insurance company, or provider if there are insurance coverage issues in order to obtain financial resolution.
• Uses work queues within the EPIC system for scheduling, transition of care, and billing edits.
• Performs medical necessity screening as required by third-party payors.
• Documents referrals/authorization/certification numbers in the EPIC system.
• Initiates charge anticipation calculations and accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
• Communicates with the patient the anticipated self-pay portion, co-payments, deductibles, co-insurance, and account balance; refers self-pay patients with limited or exhausted benefits to in-house Financial Counselors to determine eligibility.
• Assists Patient Financial Services with denial management issues and appeals denials based on medical necessity as needed.
• Communicates problems hindering workflow to management in a timely manner.
• Assesses all self-pay patients for potential public assistance through registration/billing systems.
• Provides self-pay/under-insured patients with financial counseling information.
• Maintains current knowledge of major payor payment provisions.

Skills

• Excellent oral and written communication skills.
• Basic knowledge of medical terminology.
• Basic knowledge of ICD-10 and CPT coding, third-party payors, and business math.
• General knowledge of time-of-service collection procedures.
• Excellent customer service and telephone etiquette.
• Minimum typing speed of 25 words per minute.
• Reading and comprehension ability.

Physical Requirements

• Prolonged periods of sitting.
• Extended periods on the telephone requiring clarity of hearing and speaking.
• Manual dexterity required to operate standard office equipment.

Working Environment

Standard office environment.

Schedule

Scheduled weekly hours: 4 (Non-Exempt)