Job Description

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

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, and licensure/certifications directly related to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Equal Opportunity Employer/Disabled/Veterans

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