Insurance Specialist

Job Title

Serves as a resource to Utilization Management by initiating the patient intake, insurance verification and authorization processes to ensure that care is provided in the correct setting with proper authorization and in compliance with regulatory and insurance standards. Maintains knowledge of Center Care contracts and other managed care insurance contracts. Initiates Pre-Certifications and obtains benefit information for inpatient and observation admissions.

Minimum Qualifications

Work Experience: Previous hospital and/or insurance verification or billing experience preferred.

Education: Associate's degree preferred.

Certifications/Licensure: None required.

Job Specific Performance Standards

The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.

• Verifies insurance and contacts insurance companies via phone and/or online insurance payer portals to notify for pre-certifications for inpatient and observation admissions. Verifies and assigns appropriate insurance mnemonics and information obtained into Meditech for use by Utilization Review personnel.
• Monitors the status of patient's insurance coverage and refers information to Financial Counselor as necessary. Thoroughly documents information obtained from insurance representatives into Meditech.
• Researches questionable insurance coverage and promptly communicates any identified problems to appropriate personnel for follow up.
• Monitors insurance mnemonics for accuracy, maintains spreadsheet of registration mnemonic issues and communicates with Registration Director for process improvements.
• Establishes and maintains positive working relationships with Utilization Management staff and Physician offices/clinics. Identifies opportunities for service optimization and works to act upon opportunities. Contacts physician Offices/clinics to resolve issues regarding insurance verification and prior authorization.
• Collaborates with Patient Financial Services, Patient Registration, Utilization Management, and Center Care to ensure that Med Center Health is aware of and operates in accordance with insurance front-end requirements. Notifies of any updates regarding insurance information and managed care contracts.