Insurance Verification Specialist

Insurance Verification Specialist

Pay range: $22.30 - $30.11 per hour, based on experience. This full-time position comes with a comprehensive benefits package that includes medical, dental, vision, a 403(b) retirement plan, and a generous Earned Time Off (ETO) program.

St. Charles Health System is committed to creating America's healthiest community, together. Our mission is to deliver better health, better care, and better value in the spirit of love and compassion.

The Pre-Arrival Services department specializes in ensuring that appropriate scheduling and insurance requirements are met, to ensure payment for services rendered. This team works with patients to assist them in understanding their financial responsibilities regarding treatment for hospital and professional services. This includes providing insurance verification, estimates, preauthorization, and assistance programs to best practice standards. Refers patient to other St. Charles Health System programs/departments as needed. Track and monitor services required throughout their course of care.

The Insurance Verification Specialist coordinates and performs insurance verification confirming patient participation in health plan and obtains accurate benefit coverage. Validates or obtains pre-certification requirements with the rendering physician's office, third party carriers, and managed care providers as required by the patient's medical coverage. Contacts patients to advise them of co-pays and deposits as needed. Discusses pre-existing or benefit limitations with patients, provides professional, accurate, and timely service in all admitting functions and as requested by patients/families, physicians, visitors, or other hospital representative.

Essential functions and duties include:

• Confirms patient participation in health plan and obtains accurate benefit coverage.
• Communicates appropriate provider and facility information to health plan as part of the prior authorization or admission notification process.
• Maintains working knowledge of Medicare, Medicaid, Commercial and HMO payors.
• Submits documentation to obtain authorizations, verifies authorizations that are in place and accurate for procedures.
• Contacts physician's office when authorization is missing or inaccurate.
• Monitors and complies with regular changes by insurance companies.
• Provides estimates of cost for procedures and services.
• Refers patients to SCHC financial assistance programs as needed.
• Performs duties in accordance with department guidelines, seeks direction for issues outside guidelines.
• Works in partnership with Utilization Management, Surgery Scheduling, Documentation Coordinators, Pre-Surgery Clinics, Billing, and Chargemaster.
• Supports the vision, mission and values of the organization in all respects.
• Supports the Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Provides and maintains a safe environment for caregivers, patients and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality.
• Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate.

Education: High school diploma or GED. Preferred: College courses in medical terminology.

Licensure/certification/registration: N/A

Experience: 1 year of experience in a healthcare setting and knowledge of insurance payers: Commercial, Third Party Payer, Managed Care, Medicare, Medicare Replacements, Medicaid, Government and Self Pay. Ability to use PC based office productivity tools (e.g. Microsoft, Microsoft Outlook, and Excel). Knowledge of online resources for insurance benefits coverage and limitations, use authorization grids and other resources pertaining to plan exclusions. Basic knowledge of insurance coverage terminology and benefit plan descriptions. Previous customer service experience in a fast-paced environment.

Personal protective equipment: Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

Physical requirements:

• Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
• Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation, operation of motor vehicle.
• Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing.
• Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-25 pounds, operation of a motor vehicle.
• Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level.
• Exposure to elemental factors: Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface.
• Blood-borne pathogen (BBP) exposure category: No risk for exposure to BBP.

Schedule weekly hours: 40

Caregiver type: Regular

Shift: First shift (United States of America)

Is exempt position? No

Job family: Insurance verifier

Scheduled days of the week: As scheduled (may include weekends and holidays)

Shift start & end time: Varies