Wheeling Hospital, Inc Insurance Specialist (Part Time) Wheeling , West Virginia Apply Now
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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 hereare intendedto describe the general nature of work being performed by people assigned to this position.Theyare not intended to be constructedas an all-inclusive list of all responsibilities and duties.Other dutiesmay be assigned.
- Identifies all patients requiring pre-certification or pre-authorization at the time services or when notified by another hospital or clinic department.
- Follows up on accounts as indicated by system flags.
- Contacts insurance company or employer to determine eligibility and benefits for requested services.
- Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
- Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
- Performs medical necessity screening as required by third partypayors.
- Documents referrals/authorization/certification numbers in the EPIC system.
- Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
- 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.
- Maintains current knowledge of major payment provisions and regulations.
- Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
- Abilityto accurately utilizeapplicable computer software and equipment for access processing.
- Demonstrates ability to follow established computer down time procedures.
- Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
- Follows established work systems, identifies deviations or deficiencies in standards/systems/processes and... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.Please view Equal Employment Opportunity Posters provided by OFCCP here.The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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