Insurance Eligibility Specialist MemorialCare Shared Services Fountain Valley, CA Nurse Practitioner

Insurance Eligibility Specialist

Location: Fountain Valley, CA

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Insurance Eligibility Specialist is responsible for timely and accurate verification of medical insurance benefits for both admission and pre-admission visits. The Insurance Eligibility Specialist will obtain current eligibility, verify benefit coverage, and ensure accurate information is obtained (pre-certification, authorizations & tracking numbers) and documented into the registration system to secure reimbursement. The Insurance Eligibility Specialist must be knowledgeable with insurance contracts. Ability to work from work queues and assist with training new staff. Multi-task oriented with the ability to prioritize and coordinate the essential job functions. Maintains effective working relationships with coworkers, nurses, physicians, and other hospital staff members in order to insure workflow effectiveness.

This position requires full understanding and active participation in fulfilling the mission of Memorial Care. It is expected that the employee demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion and Synergy. The employee shall support the MemorialCare Health Systems strategic plan and participate in and advocate performance improvement/patient safety activities.

Essential Functions and Responsibilities of the Job

• TIME AND ATTENDANCE: Must adhere to the MHS Time and Attendance policy, clocks "in" and "out" of MTM accurately with minimal manual clocking requests for each scheduled shift and must sign off on MTM by the end of each pay period.
• PATIENT IDENTIFICATION: Avoid HIPAA violations by accurately entering patient information into the system, adheres to policy of using 2 patient identifiers to avoid passing on defects such as, incorrect PCP, guarantor, IPA, health plan, subscriber, W/C, guarantor etc.
• DOCUMENATION AND DATA ENTRY: Inputs accurate documentation into the registration system to secure reimbursement. Ensure that all verification documentation is complete and scanned into EPIC timely. Enters notes into referral or auth/cert workflow by following the Admitting department Standard Work regarding patient benefits, out of pocket lifetime max on benefits and effective dates of insurance eligibility.
• CUSTOMER SERVICE/PROFESSIONALISM: Interact in a positive and constructive manner and must deliver excellent customer service to patients, visitors, office staff and hospital staff members in order to ensure workflow effectiveness. Must maintain an effective and professional working relationship with co-workers and others.
• ELIGBILTIY VERIFICATION: Performs insurance eligibility timely and accurately. Has the appropriate level of expertise in EPIC, OnBase, RTE, contracts and websites to ensure accurate and efficient reimbursement.
• ATTENDNACE OF MEETINGS AND PROFESSIONAL DEVELOPMENT: Participates in department specific performance improvement plan (IE: education/training, staff meetings, projects, Press Ganey employee engagement survey, Simply Better and Service excellence, etc.).
• EPIC WORK QUEUE MONITORING/PRODUCTIVITY: Monitors/manages assigned EPIC work queues ensuring immediate bill release. Responsible for meeting the department's daily productivity requirements to maximize productivity by meeting the Admitting department weekly goals.
• PATIENT ESTIMATES AND OTC CASH COLLECTIONS: Create patient estimates accurately and timely. Notifies patients of estimate amount via phone and mailed letter. Responsible for computing patient estimates and advises patients of their financial responsibility: including deposits, co-pays, deductibles, estimate's and co-insurance timely and accurately. Collects out of pocket financial liabilities from patients prior to scheduled services being rendered.
• INSRUANCE PLAN CODE SELECTION: Obtains and assign's the correct insurance plan code and IPA codes with minimal errors.
• WORKFLOW MANAGEMENT: Must posses the ability to multitask and perform multiple duties at a time due to the high patient volumes for MemorialCare Health Systems.
• Other duties as assigned

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCarethat includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family.