Insurance Specialist

Position Summary: Responsible for verifying patient insurance coverage, benefits, eligibility, and authorization requirements prior to scheduled procedures and services. Contacts patients prior to service to discuss financial responsibility, collect deposits or pre-service payments, and answer questions regarding insurance coverage, benefits, deductibles, co-insurance, and out-of-pocket expenses. Assists patients with registration activities, as needed, and serves as a liaison between patients, physician offices, insurance carriers, and hospital departments to ensure accurate financial and demographic information is obtained prior to services. Maintains confidentiality of all patient and financial information and supports the overall revenue cycle process. Essential Functions: The Insurance Specialist functions include, but are not limited to, the following: Uses computer applications and hospital information systems to verify insurance eligibility, benefits, authorizations, and patient financial responsibility. Verifies insurance coverage for all scheduled procedures and services prior to the date of service. Reviews patient accounts to determine copayments, deductibles, co-insurance, and estimated patient balances. Contacts patients to discuss financial obligations and collect required deposits, copayments, and pre-service payments. Explains insurance benefits and coverage information to patients in a professional and understandable manner. Answers patient questions regarding insurance coverage, billing processes, payment arrangements, and financial policies. Assists with patient registration, admissions, and check-in processes, as needed. Coordinates with physician offices regarding referrals, authorizations, and required insurance documentation. Communicates with insurance carriers to verify coverage, obtain benefit information, and resolve eligibility discrepancies. Identifies accounts requiring authorizations or referrals and follows established procedures to ensure approvals are obtained. Documents all insurance verification activity, patient conversations, and payment arrangements accurately within hospital systems. Assists patients with completing necessary registration and financial forms. Maintains knowledge of insurance plans, payer requirements, Medicare, Medicaid, and commercial insurance guidelines. Monitors and follows up on pending insurance verifications and authorizations. Protects the confidentiality of patient information in accordance with HIPAA and hospital policies. Answers telephone inquiries and directs calls to appropriate personnel when necessary. Establishes and maintains effective working relationships with patients, physicians, insurance representatives, and hospital staff. Demonstrates safe work habits through compliance with work-related policies and procedures. Adheres to policies, procedures, all safety plans, and all standards imposed by regulatory organizations. Demonstrates cost consciousness through efficient use of time, materials, staff, equipment, supplies, and available resources. Consistently utilizes spare time to benefit the department, patients, and co-workers. Establishes and maintains a good rapport and cooperative relationship with medical staff, co-workers, supervisors, and others. May perform other incidental tasks, as needed. Duties and Responsibilities: The Insurance Specialist responsibilities include, but are not limited to, the following: Continuously assesses and improves department performance and workflow efficiency. Demonstrates and maintains skills necessary for the position, including orientation to new technology, billing regulations, payer requirements, and procedures. Maintains current knowledge of insurance regulations and reimbursement requirements affecting hospital services. Assists with identifying and resolving insurance-related registration errors and coverage discrepancies. Supports revenue cycle goals through timely verification and collection activities. Assists patients in understanding available payment options and financial assistance resources. Participates in departmental meetings, education programs, and performance improvement initiatives. Employee reflects and is supportive of Edgewood Surgical Hospital's ethical and compliance principles in his or her daily activities. Qualifications: Must possess strong oral and written communication skills and be able to communicate effectively with patients, physicians, insurance companies, and hospital personnel. Must have the physical ability to maintain a medium percentage of sitting with occasional standing and walking. Lifting requirements are generally light. Knowledge of medical terminology, insurance terminology, and healthcare reimbursement processes. Working knowledge of Medicare, Medicaid, managed care, and commercial insurance plans preferred. Strong customer service and patient relations skills. Good planning, organizational, and time management skills. Ability to work with a high degree of accuracy and attention to detail. Ability to maintain confidentiality and exercise discretion when handling sensitive information. Ability to work well under pressure and manage multiple priorities. Ability to work effectively with others. Normal office and patient care environment with little exposure to excessive noise, dust, and temperature changes. May be exposed to communicable diseases, bloodborne pathogens, and other hazards common to healthcare settings. Demonstrated ability to work independently with minimal supervision. Professional approach to work including a strong sense of responsibility for assigned duties. Education: High School Diploma or GED required. Associate Degree in Business, Healthcare Administration, Medical Office Administration, or related field preferred. Minimum of three (3) years of medical office, registration, insurance verification, patient access, billing, or revenue cycle experience preferred. Consistently seeks continuing education activities relevant to practice areas and completes required hospital training programs. Work Location: In-person Benefits: 401(k), Health Insurance, Health Savings Account, Dental Insurance, Vision Insurance, Life Insurance, Paid Time Off. #J-18808-Ljbffr Edgewood Surgical Center