[Hiring] Patient Access Insurance Coordinator @Shriners Children's

Role Description

Under the leadership of the Corporate Patient Access Manager, the Patient Access Insurance Coordinator is an active member of the Patient Financial Services and Patient Access team that delivers support consistent with the strategic vision, goals, philosophy, and direction of Shriners Hospitals for Children.

The Patient Access Insurance Coordinator is responsible for determining the status of a patient’s insurance eligibility/coverage by contacting the appropriate insurance or third-party payor in accordance with Shriners Hospitals for Children policies and procedures, for assigned facilities. The Insurance Coordinator may also assist assigned facilities with resolving their patient access edits in the bill scrubber. A thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid, and Medicare payor guidelines and eligibility criteria is required.

This is a remote position; typical schedule 8:30am-5:00pm.

Responsibilities

• Performs insurance verification functions for assigned SHC facilities under direction from the Corporate Patient Access Manager.
• Updates encounters in SHCIS with the appropriate eligibility and COB status.
• Documents all actions taken on the account related to insurance verification in the health plan comment field on the encounter.
• Updates health plan as needed based on feedback from the insurance company.
• Maintains a detailed level of knowledge of all payors’ authorization/referral guidelines and updates all appropriate fields in SHCIS to drive encounters to worklists.
• Maintains a daily productivity log.
• Performs bill hold review for assigned facilities under direction from the Corporate Patient Access Manager.
• Reviews assigned bill hold worklists in the bill scrubber and updates the SHCIS encounter to resolve the bill hold and release the claim.
• Documents all actions taken to resolve the bill hold in the health plan comment fields on the encounter.
• Documents the action taken to resolve the bill hold in the bill scrubber and assigns back to the CBO.
• Plans and organizes the work and activities of area of responsibility to ensure department and corporate goals are met.
• Coordinates and prioritizes assigned activities to achieve maximum productivity.
• Makes recommendations to the Corporate Manager of Patient Access for quality and efficiency improvements.
• Identifies system issues, assists in identifying root causes of issues, and submits recommendations to the Corporate Manager of Patient Access and IS department for resolution.
• Completes special projects as directed by the Corporate Manager of Patient Access.
• Demonstrates a positive and professional image at all times when interacting with management, staff, and others.
• Responds positively to necessary changes in the workplace.
• Assumes responsibility for professional growth and development.
• Attends workshops and seminars, reads manuals and updates to maintain a high level of knowledge of all payor criteria.
• Maintains professional competency, according to department policies, procedures, and protocols.

Qualifications

• 3 years of insurance verification, insurance authorization experience.
• 3 years of medical billing and utilization experience.
• Strong Epic registration and scheduling experience.
• Competency in MS Office.
• High School Diploma / GED.

Requirements

• 3 years of experience working as an insurance verifier in an acute care hospital, physician practice setting, or other healthcare setting (preferred).
• Children's hospital experience (preferred).

Benefits

• Medical coverage available on the first day of employment.
• Eligibility for a 403(b) and Roth 403(b) Retirement Saving Plan with matching contributions of up to 6% after one year of service.
• Paid time off, life insurance, short-term and long-term disability for full-time and part-time employees (40+ hours per pay period).
• Flexible Spending Account (FSA) plans and Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected.
• Tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance, and more for full-time and part-time employees.
• Coverage available to employees and their qualified dependents in accordance with the plans.
• Benefits may vary based on state law.