Insurance Specialist must have a thorough understanding of the pre-certification and insurance verification process. Insurance Specialist will work closely with Case Management, Financial Counselors, and members of the Revenue Cycle Division. Insurance Specialist will also collaborate with nursing units, emergency department staff, physicians and their staff and insurance companies. Insurance Specialist will be responsible for insurance verification on a variety of patient types, which may include outpatient, inpatient or observation admissions.
1. Must follow up with Commercial and Manage Care providers, worker's compensation claims and all other payors including Medicaid and Medicare in a timely manner to ensure authorization or insurance verification.
2. Responsible for working denials through ISuites relating to Coordination of Benefits coverage, eligibility and pre-certification.
3. Reviews and responds to the #QA Patient Access email box and documents necessary corrections in Invision.
4. Utilize various online payor websites or portals, VoiCert, ORSOS and print daily census for inpatients.
Reports to: Manager, Financial Assessment Services Team and/or Manager, Access Center
Extend of Supervision Received: Varies
Minimum Education, Experience and Licensure Required:
· High School Diploma is required
· Bachelor’s degree preferred
· 4 years insurance verification and/or pre-certification experience required.
· 4-6 years experience in hospital or healthcare setting required
• High School Education, Bachelor's preferred.
• Knowledge of Third Party payers, billing requirements, and reimbursement methods.
• Knowledge of medical terminology.
• Excellent communication skills.
• Professional appearance.
• Good PC software skills.
• Must work independently and maintain workflow.
• Knowledge of multi-registration and front-end processing.
• Service excellence.
• Handle incoming calls professionally and timely.
• Demonstrate service and commitment in working with peers, management team and other hospital stall.