Position: Insurance Verification Specialist

Department: Insurance Verification

Schedule: Per Diem, Part Time

POSITION SUMMARY:

The Insurance Verification Specialist role is part of the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all referral, precertification, and/or authorization requirements as outlined in payer-specific guidelines and regulations. The role plays an important dual role by helping to coordinate patient access to care while maximizing BMC hospital reimbursement.

JOB REQUIREMENTS

EDUCATION:

• High School Diploma or Equivalent required, Associates degree or higher preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Case manager and/or coding certification desirable

EXPERIENCE:

• 4-5 years medical billing/denials/coding/and/or inpatient admitting experience desirable

KNOWLEDGE AND SKILLS:

• General knowledge of healthcare terminology and CPT-ICD10 codes.

• Complete understanding of insurance is preferred.

• Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.

• Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.

• Knowledge of and experience within Epic is preferred.

• Demonstrates technical proficiency within assigned Epic work queues and applicable ancillary systems, including but not limited to: ADT/Prelude/Grand Central, HB & PB Resolute.

• Demonstrates proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook.

• Displays a thorough knowledge of various sections within the work unit in order to provide assistance and back-up coverage as directed.

• Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Monitors accounts routed to precertification and prior authorization work queues and clears work queues by obtaining all payer specific financial clearance requirements in accordance with established management guidelines.

• Maintains knowledge of and complies with insurance companies’ requirements for obtaining pre-certifications/prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance.

• Acts as subject matter experts in navigating both the BMC Community and the payer world to get the right “permissions” (authorizations, pre-certs, referrals, for example) for the care plan to proceed.

• Uses appropriate strategies to underscore the most efficient process to obtaining authorizations, including on line databases, electronic correspondence, faxes, and phone calls.

• Obtains and clearly documents all pre-certifications/prior authorizations for scheduled services prior to admission within the Epic environment.

• Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services.

• Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required pre-certifications/prior authorizations.

• Escalates emergent and elective accounts that have been denied or will not be financially cleared within 3 days of admission as outlined by department policy.

• Keeps current on CMS requirements and guidelines.

• Coordinates with patients and Patient Financial Counseling to initiate/process Charity Care applications as needed. IND123

Equal Opportunity Employer/Disabled/Veterans