What are the responsibilities and job description for the Insurance Specialist position at Coffee Regional Medical Center?
Insurance Specialist (FT)
POSITION SUMMARY
Responsible for calculating patient financial responsibility based on network /benefits verification.
Informs appropriate staff, patient or guarantor of their financial responsibility.
Ensures accurate payer responsibility.
Obtains precert/authorizations when required.
Responsible for ensuring claims addresses are entered accurately and timely for billing parties (CBO, Lab etc.).
Assists patients/guarantor with billing inquiries in a courteous and professional manner.
Ensures accurate payer responsibility.
OVERVIEW
The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
Excellent customer service skills.
Reads and understands the English language.
Ability to think critically and analytically with little or no supervision
Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
Ability to process information and prioritize
Possesses exceptional verbal and written communication skills
Possesses independent work habits, is self-reliant and self-directed
Ability to learn, adapt, and change as required by the job functions
Ability to maintain absolute confidentiality of material and information accessed and reviewed
Basic computer literacy
Ability to move freely, reach, bend, and complete light lifting
Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
Ability to maintain attendance to meet standard job practices
B. Education
High School diploma or GED required.
Medical terminology, knowledge of insurance and reimbursement procedures preferred.
Business courses such as medical terminology, accounting, finance, cash applications, typing, and word processing preferred.
C. Licensure
None
D. Experience
2 years front end customer service experience required.
1 year physician practice related experience or equivalent required.
Experience with Mysis computer system preferred.
Knowledge of third party payers, billing requirements and reimbursement methods required.
Prior accounts receivable, collections, or billing experience preferred.
E. Interpersonal skills
F. Essential technical/motor skills
G. Essential physical requirements
Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - Greater then 75%
H. Essential mental requirements
I. Essential sensory requirements
J. Other
Excellent Customer Service Skills
Understands the current concepts of check-in and check-out reception and is able to perform the required tasks in an adequate manner.
Computer experience required; typing skills above average, effective use of number keypad.
Analytical and organizational skills must be above average.
Effective professional communication skills including proper written and spoken use of the English Language
Knowledge of medical terminology is desired
Proficiency in performance of basic math skills
Knowledge of Third Party Payers and Networks
Knowledge of billing requirements and reimbursement methods
K. Equipment used
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position's purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
o Greet and assist all patients/visitors within the office and by phone.
o Print encounter forms & pull charts daily.
o Document, prioritize and organize incoming tasks & work flow.
o Ensure that all insurance carriers are entered correctly.
o Completes insurance verification process &documents on verification sheets - based on services being rendered.
o Assist patients with billing or insurance benefits questions.
o Calculates patient liability according to verification of insurance benefits. (Attach all forms for check-out receptionist)
o Responsible for notifying patients of non-covered services, limited benefits and network info.
o Is responsible for following up on Self-Pay visits that are pending MCD Eligibility and backfilling as necessary.
o Obtains authorizations/precerts for all planned office visits/procedures & follow up.
o Responsible for gathering dictation and checking it off in a timely manner.
o Reviews each patient encounter to ensure accurate payer responsibility and correct as necessary.
o Answering telephone & assist as needed or direct calls appropriately.
o Assist with all front office duties: check-in, check-out, filing, medical records, etc.
REGULATORY COMPLIANCE
Below are any additional competencies as related to regulatory compliance that are specific to the job title and not listed in the other sections of the document.
EDUCATION AND COMPETENCY
Attends all mandatory and department-specific education and training programs as required.
Attends all required education and training and can describe his/her responsibilities related to department safety and specific job related hazards.
Has met all required competencies for the evaluation period as evidenced by job specific competency evaluations...
