Insurance Mgmt Specialist I - Atlantic Health System
Morristown, NJ
About the Job
Job Qualifications/Experience:
- High school diploma or GED.
- College degree preferred.
- Knowledge/ Experience with obtaining authorizations, familiar with insurance verifications preferred.
Duties & Responsibilities:
- Communication
- Function as a liaison between external Insurance Companies and internal staff to ensure patient needs are met.
- Notify internal staff when patient updates are required.
- Communicates with CAC & Clinical Teams to ensure required financial information is available to review with patient.
- Communicate with Clinical Teams to request necessary information for ongoing authorizations in a timely manner.
- Insurance Verification
- Verifies patient insurance for all incoming referrals for all payers.
- Verifies patient insurance during course of episode if payer change occurs or a need for re-verification arises.
- Participates in the re-verification at designated times of year, i.e. open enrollment period.
- Documents all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results.
- Authorization
- Obtain timely initial precertification and authorization for initial services when required.
- Understands and enters pending authorization as required.
- Demonstrated knowledge of payors and required documentation for precertification and authorization.
- Obtains timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements.
- Documents all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization.
- Reviews additional service request for completeness of information, accuracy and presence of required clinical data.
- Request and /or submit clinical documentation for authorization/reauthorization in Epic, prepares updates as indicated.
- Department Workflow
- Ensures coverage of department for assigned hours of operations.
- Manages assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion.
- Supports data integrity by running or working reports to identify and correct areas of inaccuracy.
- Participates as needed in the follow-up and correction of insurance and/or authorization information, including the process required for payer changes, or obtaining retro authorization.
- Participates as directed by Supervisor of Verification/Authorization in the EVV process.
- Other Duties
- Performs other duties as assigned.
- Morristown Medical Center, Morristown, NJ
- Overlook Medical Center, Summit NJ
- Newton Medical Center, Newton, NJ
- Chilton Medical Center, Pompton Plains, NJ
- Hackettstown Medical Center, Hackettstown, NJ
- Goryeb Children's Hospital, Morriston NJ
- Atlantic Rehabilitation
- Atlantic Home Care and Hospice
We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. We are part of Atlantic Accountable Care Organization, one of the largest ACOs in the nation, and are a member of AllSpire Health Partners.
We receiver awards and recognitions for what we provide to our patients, team members and communities. Below are just a few of our accolades:
- 100 Best Companies to Work For ® and FORTUNE® magazine (13 years in a row)
- Best Places to Work in Healthcare - Modern Healthcare
- 150 Top Places to work in Healthcare - Becker's Healthcare
- 100 Accountable Care Organizations to Know - Becker's Hospital Review
- Best Employers for Workers over 50 - AARP
- Gold-Level \"Well Workplace\": Wellness Council of America (WELCOA)
- CEO Cancer Gold Standard ™
- One of the 100 Best Workplaces for Millennials\" Great Place to Work® and FORTUNE® magazine
- One of the 20 Best Workplaces in Health Care: Great Place to Work® and FORTUNE® magazine
- Security 500: Security Magazine
- Official Health Care Partner of the New York Jets
- NJ Sustainable Business
Our Home care and Hospice teams work with more than our patients, we work with their families, inside their homes and in their community. When you join our team, you also join theirs, bringing them your comfort, compassion, education, and expertise. We celebrate these close connections every day, by delivering the best comprehensive home care and hospice services possible.
EEO STATEMENT
Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.
Home Care
With more than 100 years of experience, Atlantic Visiting Nurse provides high-quality nursing and rehabilitation services in the comfort of your own home. If you and your physician feel that you would benefit from home care – whether to prevent or postpone a hospitalization, or to help with recovery after a hospital stay – our team of nurses and rehabilitation experts can develop an individualized plan of care to meet your needs. We’re accredited by the Joint Commission and licensed by the New Jersey Department of Health. Atlantic Visiting Nurse - Home Health services are available to residents of Morris, Union, Essex, Sussex, Somerset and Warren counties in New Jersey.
Hospice
At Atlantic Visiting Nurse, we believe that those living with advanced illnesses should spend their final days in comfort and peace. Our compassionate, specialized care is designed to minimize patient suffering and to support families and loved ones in their roles as caregivers. As one of the first hospices in New Jersey and the United States, we have more than 40 years’ experience serving private homes, nursing facilities and assisted living facilities in Essex, Morris, Somerset, and Union counties. When patients and their primary care physicians agree that curative treatment is no longer appropriate or desired, a referral to Atlantic Hospice may be appropriate. Our hospice team works with referring doctors to develop individualized care plans that manage pain, control symptoms, and ensure dignity and respect in the final days of life. We also have nurse liaisons at Morristown Medical Center, Overlook Medical Center, Newton Medical Center, Chilton Medical Center, and Hackettstown Medical Center, as well as other health care facilities in the area, to answer questions and ease the transition to end-of-life care.
Source : Atlantic Health System