What are the responsibilities and job description for the INSURANCE DENIAL/APPEALS SPECIALIST position at MOUNTAIN VIEW HOSPITAL LLC?
Job Details
Description
Mountain View Hospital is looking for A Insurance Denial/Appeals Specialist to join our team!
JOB SUMMARY: Works to be sure all insurance is correct and appropriately entered into system. Verifies benefits and helps to coordinate patient assistance programs when necessary. Checks proposed treatment to make sure the diagnosis will support medical necessity as per insurance company and verify that all visits and diagnostic tests that need preauthorization are done
BENEFITS:
Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:
Medical, Dental and Vision Insurance
Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
Retirement Plans (401K with up to 6% match)
Earned Quarterly Bonus Program
Education Reimbursement Program
Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital
Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.
DUTIES AND RESPONSIBILITIES:
Insurance Specialist:
- Responsible for verifying insurance benefits and eligibility of oncology patients, obtaining patient information regarding copay assistance need or charity need. Responsible for obtaining preauthorization for chemotherapy, scans and other diagnostic tests.
- Communicates appropriately and clearly to the patients, supervisor, nurse managers, coworkers and physicians.
- Assists with insurance denials and with the appeal process. Helpful in researching patient accounts for insurance payment issues.
- Maintains department records, reports, forms and files.
- Maintains communication with referring physicians, insurance providers and staff to help ensure continuity of care.
- Verifies all Teton Cancer Institute patients have appropriate diagnosis for each plan of care to support medical necessity, insurance is pre-certified if necessary, and obtains a commitment for payment arrangements from patient when necessary prior to therapy.
- Responsible for knowing hospital policies and being familiar with hospital services that are available.
- Demonstrates an ability to be flexible, organized and function well in stressful situations.
- Demonstrates ability to multi-task efficiently.
- Treats patients and their families with respect and dignity; ensures confidentiality of patients’ records.
- Maintains a good working relationship both within the department and with other departments
- Participates in the educational program, completes annual educational requirements, and attends in-service meetings as required.
- Attends all meetings as required.
- Maintains patient confidentiality at all times.
- Must maintain accurate time clock punches, punch in and out according to hospital policy.
- Answers incoming calls to the facility in a professional, timely manner.
- Accepts and completes other duties as assigned or requested.
- The employee is required to comply with all PCI standards and other company policies and procedures for payment card acceptance and security.
About Mountain View:
Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.
Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.
Qualifications
Education/Certification: High school diploma or general education degree (GED).
Experience: Must have 1-5 years medical terminology experience. Experience with medical insurance is required.
Equipment/Technology: Ability to use hospital information system, and operate basic computer functions and software.
Language/Communication: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Employee must possess the ability to speak effectively, before groups of customers and or employees of the organization. Good telephone skills are a must.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Employee must possess the ability to compute rate ratios and percentages and to draw and interpret bar graphs.
Mental Capabilities: Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form. Employee must posses the ability to deal with problems involving several concrete variables in standardized situations.
Interpersonal: Ability to work well with others as well and be approachable.
