Insurance Specialist

Job Description

At Saline Memorial Hospital, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

How you'll contribute The Insurance Specialist is responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures.

Essential Functions

• Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment
• Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointment
• Heavy phone and payer website contact in accordance with payer pre-cert and verification regulations
• Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion
• Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures.
• Maintains current knowledge of outpatient imaging policies and procedures
• Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems
• Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure
• Works closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them.
• Creates and explains patient liability estimate for all scheduled and add-on procedures
• Contacts patient or physician offices when insurance information invalid or termed for all scheduled procedures
• Provides registration functions, as needed
• Performs other duties as assigned

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more

Minimum Qualifications High school diploma or equivalent - Required Two years of college or medical office specialist education - Preferred Required Skills Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Must be able to function appropriately in a multi-task setting. Working knowledge of managed care and third party payors

Minimum Work Experience One year experience with obtaining and verifying pre-certifications with various insurance companies required.