Insurance Specialist (Part Time) - UnityPoint Health

Essential Functions/Responsibilities:  

Essential functions are the duties and responsibilities that are essential to the position (not a task list).  o not include if less than 5% of work time is spent on this duty.  Be specific without giving explicit instructions on how to perform the task.  Do not include duties that are to be performed in the future.  Duties should be action oriented and avoid vague or general statements. 

% of Time

(annually)

Complex Scheduling and Registration

·         Schedules complex, multi-discipline patient appointments.

·         Monitors and completes accounts on multiple work queues in EPIC.

·         Ensures patients have eligible and active insurance prior to scheduling and helps patients understand their coverage for services. Updates registration if coverage has changed and ensures account is accurate for correct and timely claims filing.

·         Gathers billing information for patients with worker’s comp insurance (employer demographics, responsible billing party, billing address) and coordinates authorization for services.

20%

Insurance Verification/Regulations

·         Verifies eligibility and authorization needs of current and new patients for assigned departments.

·         Maintains a working knowledge of relevant regulations affecting patients and the operation of our business.

·         Assists in educating and acts as a resource to clinical and non-clinical staff related to coding and insurance regulations.

·         Provides patient notification of insurance coverage and estimated responsibility, which may include coordination with Price-line and counseling patient on process for prompt pay and financial assistance applications.

·         Accurately enters required information into EPIC account notes.

20%

Pre-Authorizations

·         Establishes effective rapport and works closely with clinical staff, doctor’s offices, patients and families to ensure that all patients have authorization for services.

·         Initiates and coordinates prior authorization requests to third party payers and maintains a working knowledge of third-party payer guidelines. Follows up with third-party payers as necessary.

·         Contacts patients and providers with authorizations or denials as applicable.

·         Meets specified deadlines as required for continuity of ongoing patient care and patient satisfaction.

20%

Accurate Billing

·         Performs charge and documentation audits to ensure proper payment for assigned departments and compliance to insurance and government regulations. Correct charges and coding as needed.

·         Runs revenue & usage reports to ensure timely billing and correct coding for patients served.

·         Works with schedulers and clinical staff to improve processes and documentation to increase reimbursement and avoid denials.

15%

Denials/Billing Issues

·         Problem solves, analyzes and collaborates with patient, therapist, central billing office, revenue cycle department, and insurance companies to identify and resolve billing and denial issues, including sending appeals and trouble-shooting and correcting claim or account errors.

·         Documents denials and billing issues to identify processes that need improvement in order to maximize efficiency and ensure proper payment within the department(s).

·         Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.

·         Handles next tier troubleshooting and escalations of billing and insurance concerns from patients, scheduling & billing specialists or providers.

·         Establishes and maintains accurate files using word processing and spreadsheet documents.

·         Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information related to billing/insurance/denials.

15%

Basic UPH Performance Criteria         

·         Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

·         Demonstrates ability to meet business needs of department with regular, reliable attendance.

·         Employee maintains current licenses and/or certifications required for the position.

·         Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

·         Completes all annual education and competency requirements within the calendar year.

·         Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse.  Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff.  Takes appropriate action on concerns reported by department staff related to compliance.

10%

Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee.  Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Demonstration of UPH Values and Standards of Behaviors

Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities

Foster Unity:

·         Leverage the skills and abilities of each person to enable great teams.

·         Collaborate across departments, facilities, business units and regions.

·         Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment: 

·         Connect with each person treating them with courtesy, compassion, empathy and respect.

·         Enthusiastically engage in our work.

·         Accountable for our individual actions and our team performance.

·         Responsible for solving problems regardless of the origin.

Champion Excellence:

·         Commit to the best outcomes and highest quality.

·         Have a relentless focus on exceeding expectations.

·         Believe in sharing our results, learning from our mistakes and celebrating our successes.

Seize Opportunities:

·         Embrace and promote innovation and transformation.

·         Create partnerships that improve care delivery in our communities.

·         Have the courage to challenge the status quo.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

High School/GED.

Associate Degree.

Bachelor’s Degree.

Experience:

Previous customer service experience.

Minimum of 1-year prior secretarial experience in medical environment.

Requires knowledge of commercial and worker’s compensation insurance.

Extensive knowledge of Medicare, Medicaid, ICD-10, CCI edits, local payer coding and billing guidelines as they pertain to physical, occupational, or speech therapy.

License(s)/Certification(s):

Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Knowledge of medical terminology.

Knowledge of medical billing and insurance.

Strong problem-solving skills.

Proficient in Microsoft office.

Demonstrate a professional image in dealing with the public, patients, families, payers and doctor’s offices.

Understanding of ICD (International Statistical Classification of Diseases and Related Health Problems) 10 Codes and Current Procedural Terminology (CPT) Coding.

Knowledge of EPIC.

Other: