Insurance Reimbursement Specialist - FT - Day

Description

Summary :

The Insurance Reimbursement Specialist is responsible for coordination and support of initiatives relative to the registration functions, evaluation and handling of insurance verification / authorizations and patient benefits. Acts as a liaison between the insurance providers and agents, claimants, and policy holders regarding the status and eligibility for coverage for rehab services. This role is also an experienced back up to all other outpatient rehab support functions to include patient appointment scheduling, coverage of front desk, answering phones, checking in patients, and collecting co-pays.

Responsibilities :

1. Performs insurance eligibility verification / authorization and executes payor requirements as needed. Includes initiating eligibility transactions to obtain necessary billing information and authorization, referrals for service when appropriate.

2. Obtains and understands necessary clinical information (including diagnoses) for registration to initiate requests for authorizations.

3. Ensures that proper selection of insurance, plan type, financial obligations, pre-certification and billing address are assigned in the system.

4. Communicates and updates all information in medical record pertaining to patient�s financial obligations to individual therapy sites, clinicians and billing office to ensure all therapy treatments are authorized. This includes but not limited to copayments, deductibles, self-pay rates, in-and-out of network responsibilities, referrals, authorizations and other information as needed.

5. Answers patient inquiries regarding their liability and able to explain variables involved and assists in mitigating any issues or barriers that may come up. Determines need for financial counseling and directs patient to appropriate Nuvance Health resources.

6. Collaborates with business office, clinical teams and patient for the additional documentation request, denial and appeals process, as necessary.

7. Serves as back-up to other administrative functions as needed to include registering patients, scheduling patients, managing front desk operations (answering phones, collecting co-pays, etc..) and tracking plans of care.

8. Fulfills all compliance responsibilities related to the position.

9. Performs other duties as assigned.

Education : HS GRAD / EQUIVALENT

Other Information :

Minimum 1 year of clerical or customer service oriented experience.

Experience with medical terminology, billing procedures, medical records.

Basic knowledge of payor guidelines.

Working Conditions :

Manual : Little or no manual skills / motor coord & finger dexterity

Occupational : Little or no potential for occupational risk

Physical Effort : Sedentary / light effort. May exert up to 10 lbs. force

Physical Environment : Generally pleasant working conditions

Company : Danbury Hospital

Org Unit : 1874

Department : Rehab Services Admin

Exempt : No

Salary Range : $18.97 - $35.21 Hourly