POSITION
DESCRIPTION
|
POSITION SUMMARY: Insurance Specialist is responsible for assuring
all appointments and procedures are authorized. 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. |
MINIMUM
QUALIFICATIONS: |
|
EDUCATION, CERTIFICATION, AND/OR LICENSURE: |
|
1. |
High
school graduate or equivalent. |
CORE DUTIES AND RESPONSIBILITIES: The
statements described here are intended to describe
the general nature of work being performed by people assigned to this
position. They are
not intended to be constructed as an all-inclusive list of all
responsibilities and duties. Other
duties may be assigned. |
|
1. |
Identifies all patients
requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or
clinic department. |
2. |
Follows up on accounts
as indicated by system flags. |
3. |
Contacts insurance
company or employer to determine eligibility and benefits for requested
services. |
4. |
Follows up with the
patient, insurance company or provider if there are insurance coverage issues
in order to obtain financial resolution. |
5. |
Use work queues within the EPIC system for scheduling, transition of
care, and billing edits. |
6. |
Performs medical necessity screening as
required by third party payors. |
7. |
Documents
referrals/authorization/certification numbers in the EPIC system. |
8. |
Initiates charge
anticipation calculations. Accurately
identifies anticipated charges to assure identification of anticipated
self-pay portions. |
9. |
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 the in-house Financial
Counselors to determine eligibility. |
10. |
Maintains current
knowledge of major payor payment provisions and
regulations. |
11. |
Assists
Patient Financial Services with denial management issues and will appeal
denials based on medical necessity as needed. |
12. |
Ability
to accurately utilize applicable computer software
and equipment for access processing. |
13. |
Demonstrates
ability to follow established computer down time procedures. |
14. |
Participates in educational
programs to meet mandatory requirements and identified needs with regard to
job and personal growth. |
15. |
Follows established
work systems, identifies deviations or deficiencies in
standards/systems/processes and communicates problems to supervisor or
manager) |
16. |
Maintains
confidentiality according to policy when interacting with patients,
physicians, families, co-workers and the public regarding
demographic/clinical/financial information. |
17. |
Is polite and
respectful when communicating with staff, physicians, patients and
families. Approaches interpersonal
relations in a positive manner. |
18. |
Uses
hospital communications systems (fax, pagers, telephones, copiers, scanners,
and computers) in accordance with hospital standards. |
19. |
Communicates problems
hindering workflow to management in a timely manner. |
20. |
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. |
PHYSICAL REQUIREMENTS: The physical
demands described here are representative of those that must
be met by an employee to successfully perform the essential functions
of this job. Reasonable accommodations may be made
to enable individuals with disabilities to perform the essential functions. |
|
1. |
Prolonged periods of sitting. |
2. |
Extended periods on the telephone
requiring clarity of hearing and speaking. |
3. |
Manual dexterity required to operate
standard office equipment. |
4. |
Must have manual dexterity to operate
keyboards, fax machines, telephones and other business equipment. |
WORKING ENVIRONMENT: The work
environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions. |
|
1. |
Outpatient
clinical environment. |
SKILLS AND ABILITIES: |
|
1. |
Excellent oral and written
communication skills. |
2. |
Basic knowledge of medical terminology. |
3. |
Basic knowledge of ICD-10 and CPT coding. |
4. |
Basic knowledge of third party payors. |
5. |
Basic
knowledge of business math. |
6. |
General
knowledge of time of service collection procedures. |
7. |
Excellent
customer service and telephone etiquette. |
8. |
Minimum
typing speed of 25 works per minute. |
9. |
Must
have reading and comprehension ability. |
Date
Reviewed/Revised: August 2017 |