Insurance Specialist - Med Center Health

• Position Summary
  • Completes all insurance verification and pre-registration for all outpatient scheduled patients. Obtains and/or verifies authorizations on all scheduled patients. Arranges for the efficient and orderly admission of inpatients and admissions of individuals who have hospital-based outpatient testing or procedures. Ensures that the patient information is collected and that patients are aware of hospital policies and procedures. Interviews incoming patients or representatives and accurately enters information required for admission into computer database. Accurately enters all outpatient orders in the HMS system. Distributes appropriate information to ancillary departments. Attempts to collect all co-pays and deductibles for applicable customers in a professional manner at time of registration.
• Minimum Qualifications
  • Work Experience
    • Previous hospital and/or insurance verification or billing experience preferred.
  • 
    Education
    • High School Diploma
    • Completed medical terminology course preferred
  • 
    Certifications/Licensure
    • None required.
• Job Specific Performance Standards
  • The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.
    
    • Verifies insurance and contacts insurance companies via phone and/or online insurance payer portals to notify for pre-certifications for inpatient and observation admissions. Verifies and assigns appropriate insurance mnemonics and information obtained into Meditech for use by department personnel.
    • Monitors the status of patient’s insurance coverage and refers information to Financial Counselor as necessary. Thoroughly documents information obtained from insurance representatives into Meditech.
    • Researches questionable insurance coverage and promptly communicates any identified problems to appropriate personnel for follow up.
    • Monitors insurance mnemonics for accuracy, maintains spreadsheet of registration mnemonic issues and communicates with Manager for process improvements.
    • Establishes and maintains positive working relationships with t staff and Physician offices/clinics. Identifies opportunities for service optimization and works to act upon opportunities. Contacts physician Offices/clinics to resolve issues regarding insurance verification and prior authorization.
    • Collaborates with Patient Financial Services, Patient Registration, Utilization Management, and Center Care to ensure that Med Center Health is aware of and operates in accordance with insurance front-end requirements. Notifies of any updates regarding insurance information and managed care contracts.

PI251723957