Insurance Specialist

Position Summary:


Performs registration functions in an effective and efficient manner to enhance coding, billing and case coordination efforts. Makes appropriate independent decisions that require assessment, reasoning and resolution regarding financial requirements to assure appropriate reimbursement for both the patient and the hospital. Performs prior authorizations for patients admission/surgeries to ensure reimbursement for services and participates in denials management activities. Interprets and applies hospital policies regarding financial resources and arrangements. Uses exquisite customer service skills when handling patient encounters/issues.

Qualifications:


EDUCATIONAL REQUIREMENTS
Associate's Degree in Related Field

CERTIFICATION & LICENSURE REQUIREMENTS
None Specified

EXPERIENCE REQUIREMENTS
Business Services or Financial Services. Customer service, handling difficult situations with customers/patients, medical/hospital practice experience.

OTHER REQUIREMENTS
Keyboarding ability required. Deals effectively with stressful situations and maintains composure at all times. Ability to prioritize and multi-task for long periods of time. Insurance knowledge and basic understanding.

Essential Functions:

• Accurately explains and completes registration and admitting forms. Obtains signatures from patients and policyholders. Explains and gets patient signatures for Consents, Assignment of Benefits, ABN's and Notice of Non Coverage forms.
• Communicates detailed information clearly, concisely, actively, and in a timely manner.
• Completes Medicare Secondary Payer (MSP) form in accordance with Medicare laws. Follows up on necessary information.
• Interpretsinsurance coverage and benefits to patients.
• Interviews and identifies patients with the potential for financial hardship and/or without third-party coverage and works with the patient for resolution. Provide essential information regarding Carle's Financial AssistanceProgram or payment arrangements
• Obtains, updates and verifies patient demographics, insurance and co-pays and Primary Physicians.
• Performs chart management duties proficiently by ordering, sending, and receiving charts when necessary. Creates new clinic charts and medical record numbers for new patients.
• Performs insurance eligibility verification by using Nebo for payer information when possible. Understands terms and information listed on Nebo reports.
• Performs prior authorizations for patients admission/surgeries to ensure reimbursement for services and participates in denials management activities.
• Receives and posts co-payments as identified by third-party payers or patient insurance cards. Maintains cash drawers and balances according to procedures.
• Registers all patients at each visit utilizing established policies for the capture of complete and up-to-date patient and insurance information.
• Reviews, analyzes, and communicates registration errors to HRC management for quality improvement. Strives 5% or less error rate.
• Scans all required patient information into software systems so that information is retrievable and accessible by hospital staff.
• Understands, reviews and explains Patient Rights & Responsibilities, Notice of Privacy, and other pertinent admitting information to the patient and/or family member.