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Part Time Insurance Verification Specialist
About the position
Responsibilities
- Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral
- Initiate contact with payers to complete insurance verification activities to prevent delays in care due to missing authorizations
- Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered
- Navigate EMR, insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization
- Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care
- Update health record with accurate information regarding insurance coverage based on information gathered during verification &/or authorization process
- Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, departments & modalities across the continuum
- Identify/escalate barriers to obtaining authorization to the insurance company or per department protocol
- Respond to insurance company inquiries for information including consent forms, pre-authorization forms, 2nd opinion forms & referral forms
- Coordinate with providers, payers, departments, & patients regarding authorization status and options & document outcomes in the EMR
- Confirm payment coverage including the initiation of insurance & managed care authorizations
- Communicate with providers & clinical delegates to resolve any outstanding information regarding pre-authorization & referral requirements
- Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits assigned
- Complete assigned tasks in EMR work queues & bring work lists to completion
- Generate forms to insurance companies: consent, pre-authorization, second opinion and referral
- Notify provider of denied procedure/request for peer-to-peer discussion with insurance company & adjust authorization status accordingly
- Work independently & as part of a team in conjunction with Utilization Review/other departments as necessary to provide appropriate clinical information from the EMR to appeal the denials from the insurance company
- Follow-up discharge status of patients & relay information to insurance carriers as they require
- Actively participate in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriately
- Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization
Requirements
- High School Diploma/GED (or higher)
- 1+ years of experience in medical billing, medical insurance verification, managed care and/or patient registration
- 1+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers
- 1+ years of experience working with an EMR system
- Intermediate level of proficiency with Microsoft Office products
- Ability to work 20 hours per week, from 8:00am - 4:30pm CST Mondays and Fridays and 8:00am-12:00pm Wednesdays
- Must be 18 years of age or older
Nice-to-haves
- 1+ years of experience in an acute care billing/insurance verification/managed care/registration department
- Previous experience with prior authorizations and referrals
- Previous experience with Epic medical record and medical terminology
- Epic experience
Benefits
- \$2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
