Patient Access Insurance Specialist

About the role

Reports to the Patient Access Director or the Insurance Specialist Supervisor. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider.

Responsibilities

• Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider.
• Audit the MSP (Medicare Secondary Payor) questionnaire by verifying that all fields are completed.
• Verifies insurance coverage by calling the insurance company or using online eligibility systems to determine the patient's benefits under the insurance plan.
• Obtains VOB information from the insurance company, such as: co-payment, co-insurance, deductible, the amount of the deductible that has been met year-to-date, family deductible, maximum out-of-pocket limit and rehabilitation benefits.
• Runs insurance eligibility software, make needed phone calls to insurance companies, fax authorization requests.
• Validating medical necessity via the Cerner Medical Necessity Checker where applicable.
• Ensures all authorization obtained from referring facilities are accurate and complete.
• Identify out of network insurance plans and follow the out of network policy.
• Prepare Indiana Medicaid/HIP Universal PA form for Utilization Review.
• Works closely with the physician office staff to ensure that pre-cert/pre-authorization numbers are obtained & entered in the registration system.
• Communicates with the Supervisor (or Director) regarding any concerns or problems.
• Provides world class service at all times.
• Completes other job-related duties as assigned.

Qualifications

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent).
• A minimum of two years of experience in a hospital or physician practice business office is required.
• Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required.
• A medical terminology course must be successfully completed prior to employment.
• Associate's degree preferred.
• Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.

Skills

• Basic office and keyboarding skills (with the ability to type a minimum of 40 wpm)
• Effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals)
• Proficient computer skills (i.e., data entry, word processing and spreadsheets)
• Multiple databases (such as Pathways Healthcare Scheduling, Experian, Cerner and MCA Compliance Checker)
• Understanding of time-of-service collections
• Knowledge of medical terminology, private insurance coverage (and managed care), insurance networks, ICD10, and CPT codes
• Interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner
• Ability to utilize good judgment and maintain one's composure in stressful situations
• Basic math skills needed to calculate patient's insurance benefits such as deductible, coinsurance, and out of pocket

Benefits

Not specified.

Pay

Not specified.

Schedule

Monday - Friday schedule (no nights, weekends or holidays).