Insurance Verification Specialist

Description

Purpose

The Intake Financial Clearance Specialist role belongs to the Revenue Cycle team and is responsible for coordinating all financial clearance activities by navigating all pre-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s). The role ensures timely access to care while maximizing reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. This position reports to the Intake Financial Clearance Manager and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, and practice staff.

**This is a fully remote role**

 Responsibilities

• Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines.
• Maintains knowledge of and complies with insurance companies' requirements for obtaining prior authorizations/referrals and completes other activities to facilitate all aspects of financial clearance.
• Acts as subject matter experts in navigating payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the ordered services to proceed. The Intake Financial Clearance Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services.
• Supports staff at all levels for hands-on help understanding and navigating financial clearance issues.
• Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations, and referrals, including online databases, electronic correspondence, faxes, and phone calls.
• Obtains and clearly documents all referral/prior authorizations for scheduled services
• Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded in the relevant systems.
• When it is determined that a valid referral does not exist, utilize computer-based tools, or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
• Contact physicians to obtain referral/authorization numbers.
• Perform follow-up activities indicated by relevant management reports.
• Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients' scheduled services.
• Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
• Work collaboratively with the practices to resolve registration, insurance verification, referral, or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.
• Escalates accounts that have been denied or will not be financially cleared as outlined by department policy
• Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients.
• Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary, and tertiary insurances.
• Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow-up is required, and at all times maintain sensitivity and a clear customer friendly approach.
• For self-pay patients or patients with unresolved insurance, and for financial counseling, refer patients Patient Financial Counseling.
• Maintains confidentiality of patient's financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately.
• Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations.
• Demonstrates the ability to recognize situations that require escalation to the Supervisor.
• Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement aligned with management expectations as outlined.
• Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed.
• Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities.
• Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party.
• Communicate with all internal and external customers effectively and courteously.
• Maintain patient confidentiality, including but not limited to, compliance with HIPAA.
• Perform other related duties as assigned or required.

Requirements

Qualifications 

• High School Diploma or GED required, Associates degree or higher preferred.
• 1-3 years patient registration and/or Insurance experience desirable. At least one year of experience must be in a customer service role
• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Complete understanding of insurance is required.
• Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.
• Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers.
• Able to communicate effectively in writing.
• Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.
• Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
• Must be able to maintain strict confidentiality of all personal/health sensitive information.
• Ability to effectively handle challenging situations and to balance multiple priorities.
• Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom.
• Displays a thorough knowledge of various sections within the work unit to provide assistance and back-up coverage as directed.
• Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management

Salary & Benefits  

The estimated hiring salary range for this position is $22/hr - $24/hr. * The actual salary will be based on a variety of job-related factors, including geography, skills, education and experience. The range is a good faith estimate and may be modified in the future. This role is also eligible for a range of benefits including medical, dental and 401K retirement plan.