Insurance Specialist - Orthopedic Surgery

SHIFT:

• Responsible for verifying and authorizing the insurance of all new patients referred as well obtaining emergency authorization for scans/tests for all existing patients.
• Obtain authorization for all non par scans or procedures for all patients
• Communicates directly with disease specialists and clinical staff regarding status of authorization and the need for clinical documentation
• Verify coverage & benefit information via electronic eligibility or by contacting the payer
• Document all relevant information into EPIC
• Partners with Single Case Agreement Department to facilitate authorizations
• Establishes process with Revenue Cycle to insure collection of payment, especially for non par insurance companies
• Partners with Revenue Cycle and billing to collect any backlogged revenue
• Educates families and clinical team regarding insurance coverage plans.
• Communicates with family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party.
• Respond to emails, answer calls, provide explanation of covered and non-covered services
• Contacts appropriate clinical staff in timely manner with all information that requires follow-up.
• Develop and maintain systems to streamline communication with staff on all aspects of insurance
• Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs and refer to FHCC when appropriate.
• Training/Education Responsibilities
• Provides onsite training to scheduling, intake and registration staff with regard to insurance matters
• Educates providers, intake coordinators and families on insurance issues
• Assists in creating brochure which provides insurance information for families
• Creates templates with correct CPT Codes for specific services for Single Case Agreement
• Registration Responsibilities
• Create and/or update patient record by verifying demographic, insurance information, or proper study identification in the registration system
• Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payer plan entries for research and standard-of-care visits
• Verify coverage through Navinet/Passport, etc. and pull appropriate referrals.
• Coordinate & communicate insurance issues with appropriate personnel (e.g. schedulers, Pre-cert dept, out-of -area dept, Self-Pay group, Single Case Agreement Team and PCP's staff when required.
• Educate and inform family of outstanding financial obligations if appropriate. Provide documentation in Guarantor's Notes in Epic.
• Electronically collect or facilitate payment of outstanding balances

• High School Diploma / GED Required
• Associate's Degree Preferred
• Bachelor's Degree Preferred

• At least five (5) years related healthcare registration, billing and/or reimbursement experience Required
• Previous experience in complex clinical setting that required coordination of multiple services Required
• Background in Medical Insurance Required
• Resource scheduling experience (e.g. ancillary testing) Preferred

• Advanced insurance authorization and registration techniques
• Ability to provide training to staff in complexity of Insurance Authorization
• High level of interpersonal skills with excellent customer service and responsiveness
• Background in medical terminology
• Strong Customer Service experience required
• Ability to multi-task and prioritize is crucial to success in the position
• Individual must be highly organized and dependable
• Ability to prioritize and work on several projects at once while maintaining communication with all invested parties.
• Strong communication skills
• Ability to work with stressful situations
• Ability to function efficiently and professionally with minimum of supervision.
• Ability to quickly learn new procedures.
• Strong computer skills.
• Ability to juggle multiple insurance issues.
• Strong customer service skills
• Ability to display compassion and empathy
• Website Insurance Training (Navinet, WebMD, Passport)
• EPIC training & testing (Prelude/Cadence).
• Registration Essentials