[Hiring] Insurance Verification Specialist @Vital Connect Inc

Role Description

The Intake Financial Clearance Specialist role belongs to the Revenue Cycle team and is responsible for coordinating all financial clearance activities by navigating all pre-registration, obtaining referral authorization, or precertification number(s). The role ensures timely access to care while maximizing reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. This position reports to the Intake Financial Clearance Manager and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, and practice staff.

This is a fully remote role

Responsibilities

• Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines.
• Maintains knowledge of and complies with insurance companies' requirements for obtaining prior authorizations/referrals and completes other activities to facilitate all aspects of financial clearance.
• Acts as subject matter experts in navigating payer policies to get the appropriate approvals for the ordered services to proceed.
• Supports staff at all levels for hands-on help understanding and navigating financial clearance issues.
• Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations, and referrals.
• Obtains and clearly documents all referral/prior authorizations for scheduled services.
• Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded in the relevant systems.
• Utilizes computer-based tools or contacts the appropriate party to obtain/generate referral/authorization and related information when a valid referral does not exist.
• Contacts physicians to obtain referral/authorization numbers.
• Performs follow-up activities indicated by relevant management reports.
• Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients' scheduled services.
• Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
• Works collaboratively with the practices to resolve registration, insurance verification, referral, or authorization issues.
• Escalates accounts that have been denied or will not be financially cleared as outlined by department policy.
• Accepts registration updates from various intake points and ensures that all updated demographic and insurance information is accurately recorded.
• Reviews all registration and insurance information in systems and reconciles with information available from insurance carriers.
• For self-pay patients or patients with unresolved insurance, refers patients to Patient Financial Counseling.
• Maintains confidentiality of patient's financial and medical records; adheres to State and Federal laws regulating collection in healthcare.
• Demonstrates knowledge & skills necessary to provide a level of customer experience as aligned with management expectations.
• Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement.
• Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives.
• Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities.
• Handles telephone calls in a timely fashion, following applicable scripting and customer service standards.
• Communicates with all internal and external customers effectively and courteously.
• Maintains patient confidentiality, including compliance with HIPAA.
• Performs other related duties as assigned or required.

Qualifications

• High School Diploma or GED required, Associates degree or higher preferred.
• 1-3 years patient registration and/or Insurance experience desirable.
• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Complete understanding of insurance is required.
• Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking, and creativity when resolving customer issues.
• Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers.
• Able to communicate effectively in writing.
• Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.
• Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
• Must be able to maintain strict confidentiality of all personal/health sensitive information.
• Ability to effectively handle challenging situations and to balance multiple priorities.
• Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information.
• Displays a thorough knowledge of various sections within the work unit to provide assistance and back-up coverage as directed.
• Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management.

Requirements

• The estimated hiring salary range for this position is $22/hr - $24/hr.
• The actual salary will be based on a variety of job-related factors, including geography, skills, education, and experience.
• This role is also eligible for a range of benefits including medical, dental, and 401K retirement plan.