Insurance Specialist

Insurance Specialist

Nemours is hiring an Insurance Specialist in Pensacola, FL. Utilizing high-level customer service, healthcare finance knowledge, and excellent communication skills, the Insurance Specialist will evaluate a patient's insurance status and assist with ensuring eligibility of coverage for timely and efficient billing. The work includes accessing our partner hospital's electronic health record to verify insurance eligibility. Continuously monitor accounts to place appropriate insurance, or eligible charity care programs to ensure timely filing.

The Insurance Specialist validates all pertinent demographic and insurance information is available and accurately documented. Work involves contacting guarantors to obtain information, communication with partner hospitals, and learning our partner hospital's electronic health record software for continuous monitoring of accounts for proper documentation, insurance verifications, and collection of deposits and self-pay balances. Associate may be required to be subject to background checks for our partner hospitals to provide them with access to their electronic health record.

Associate support and serve as a resource, which includes cross covering Family Financial Advocate functions within the team by providing cost estimates to patients and providers, and approving discounts in accordance with organizational and government policies.

Essential Functions

1. Protects the financial standing of Nemours by performing methodical and thorough financial assessments of our uninsured and/or underinsured patients assisting in applications for federal, state, and local programs.
2. Access partner hospital's electronic health record system for monitoring updates regarding insurance coverage. Verify and assure all accounts are ready for billing with adequate supporting documentation, within the established time frames. Responsible for the quality integrity related work revolving around Accounts Receivable & Self Pay Process.
3. Supports patients and their family members to assure patients have access to all available funding. This involves, working with private as well as governmental agencies, i.e., private insurance, HMO/PPO's, Medicaid, Kidcare, Medicare, Champus, and Third-Party Liability payers.
4. Ensure compliance with hospital financial resolution policies, including conducting financial interviews with patients and families to assist with resolution of their account.
5. Aid in customer service resolution with concerns regarding financial services. Including but not limited to giving advice and counsel to patients and guarantors of their rights, responsibilities, and procedures about payment for care.
6. Create patient responsibility estimates based on the insurer's coverage and benefit information, as well as collect applicable patient responsibility portion.
7. Communicates on behalf of financial services with other specialty clinic locations and physician offices. Handles inbound and outbound calls including but not limited to customer service calls, account inquiries and coverage benefits and eligibility status.
8. Convey courtesy, dignity, respect and a positive attitude through words and actions to establish harmonious relationships with all individuals. Demonstrate effective communication and respect by using active listening skills, positive body language and effective verbal, written and electronic forms of communication. Demonstrate care and concern and inclusion when interacting with and informing customers by consistently using A.I.D.E.T and protecting confidentiality and privacy.
9. Responsible for the quality integrity related work revolving around Accounts Receivable & Self Pay Process.
10. May support with scheduling functions, other projects, and duties as assigned by supervisor.

Requirements

Associate Degree or Minimum 3 years of hospital experience and working knowledge of patient accounting functions including pre-admissions and admission registration will be considered in lieu of an Associate Degree.

Minimum 1 year Family Financial Advocate experience, in addition to Registration, insurance, billing, and/or relevant experience required for FA I.