Insurance Specialist; BHS

Job Summary

Reports and works under the direction of the Department Director/Manager/Supervisor. Reviews patient records using medical coding procedures. Verifies insurance eligibility and ensures the patients healthcare benefits cover the required procedures. Assists in educating patients regarding insurance. Coordinates daily administrative activities and patient support functions within the department. Ensures the appropriate and accurate documentation is maintained. Facilitates communication and serves as a resource to staff and patients as appropriate.

• MISSION
  :
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES
  :
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS
  :
  Personally connect. Keep everyone informed. Be on their team.

• Answers the many questions phoned in regarding insurance problems.
• Delivers accurate documentation to insurance companies.
• Works closely with physicians and clinical staff to obtain prior authorizations for treatments, procedures and medications.

• Reviews all insurance bulletins for coding changes.
• Verifies treatment meets medical necessity per diagnosis given by providers.
• Refers any questionable diagnosis issues to the manager/director or clinic coordinator for clarification.

• May audit billing for correct documentation required for reimbursement.
• Communicates and educates physicians and staff associates on any documentation issues in a timely manner to correct errors or omissions in the medical record.

• Works closely with patient accounts to properly follow up on insurance company appeals and denials.

• Attends meetings regularly to stay abreast of insurance matters.
• Builds a rapport with key people at insurance companies to consult when problems arise.
• Maintains online insurance portal knowledge and usage.

• Processes reports per established schedule and as requested.
• Serves as an on-site insurance specialist resource to department associates and physicians.
• Serves as a liaison and works closely with patient accounts, medical records, and department associates.
• Assists the director/manager/supervisor and clinic coordinator with updating and training staff on coding changes.
• Communicates via telephone and in writing with patients, employers, and third‑party payers.
• Verifies that the billing exported out of the department matches charges that are uploaded into the hospital and physician billing systems.
• Completes other job‑related duties and projects as assigned.

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department‑specific education within established time frames.
• Completes annual employee health requirements within established time frames.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

A health insurance specialist must have extensive knowledge of the latest alphanumeric codes used in medical billing. Post‑secondary training is required. The knowledge, skills, and abilities as indicated above are normally acquired through the successful…