Insurance Verification and Authorization Specialist II

Location: Kent Campus Hospital

Status:Full Time 80 Hours

Shift: Day/ Evening

SALARY RANGE: 18.17 - 26.51HOURLY

General Summary:

The Insurance Verification and Authorization Specialist II provides excellent customer service while performing complete and accurate registration and authorization functions to provide information for continuity of care and revenue cycle efficiency. Requires excellent organizational and time management skills, ability to work independently and to deal with constant changes in work routines and priorities as well as perform multiple tasks simultaneously. Verifies insurance benefits, makes pre-certification requests, and obtains authorizations for services. The Insurance Verification and Authorization Specialist II performs other duties as assigned to support the department’s needs and policy changes.

Responsibilities:

1. Request, track and obtain insurance authorizations and pre-certs for patient services within time allotted for treatment for Bayhealth and referring physicians (if appropriate).
2. Ensure request for authorization is timely and handled in accordance with departmental policy and payer requirements.
3. Maintains performance standards.
4. Required to utilize all available resources to verify eligibility, benefit levels, and patient copayment/coinsurance responsibilities.
5. Validates coordination of benefits between insurance carriers
6. Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements.
7. Verifies or obtains referring physician authorizations (if appropriate) and ensures all diagnosis and procedure codes are accurate and appropriate prior to service delivery.
8. Maintain knowledge of insurance company requirements
9. Identifies copayment, deductible and co-insurance information.
10. Explains insurance plan coverage and benefits to patients, as necessary.
11. Validates all services.
12. Works closely and collaboratively with physician offices.
13. Reviews insurance coverage information with patient.
14. Coordinates and obtains the ABN from patient when indicated.
15. Screens patients for financial assistance programs and initiates applications.
16. Provides the lead, supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
17. Build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
18. Assist with training of new team members.
19. Follow all newly implemented workflows including those developed by Continuous Improvement projects.
20. Works directly with clinical staff to assure appropriate charge capture and authorizations are received when services/treatments are altered.
21. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education: High School Diploma or GED
  ;
  ;
  
• Credential(s): None Required
  ;
  
• Experience:

  Required: Two years of medical office/insurance experience, with administrative billing functions, health information systems.
  

  Preferred: Three years of medical office/insurance experience, with administrative billing functions, health information systems. Experience working in a high-volume call center.

Preferred Education, Credential(s) and Experience:

• Education: Associate Degree
  Business
  Or Associates Degree in healthcare related field or a graduate of a medical/practical nursing licensed technical program.
  
• Credential(s): Certified Revenue Cycle Representative
  
  
• Experience:

To view a full list of all open position at Bayhealth, please visit:

https://apply.bayhealth.org/join/