EES Insurance Specialist - Valley Baptist

Conifer Health Solutions•Harlingen, TX

16h

About The Position

JOB SUMMARY The Insurance Specialist is tasked with identifying candidates for the Health Insurance Premium Payment (HIPP) program. In addition to assisting with identifying the potential candidates, other responsibilities will include assistance with enrollment, working closely with family and the agency through the enrollment process; identify all sources for payment, documenting accounting system including progress notes and all required activities to ensure accurate reporting and following the case through the approval process. This individual will work closely with the EES onsite teams to coordinate the patient’s application process ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Performs an in-depth analysis of all inventory identified as eligible. The analysis includes, but not limited to review of patient’s demographics, payor data review, understanding payor methodology, commercial vs. government payor structures. Working knowledge of chronic illnesses, researching, and understanding of diagnosis and patient’s prognosis, reviewing medical records as necessary to determine eligibility Develop a working relationship with patient and/or family through application process for completion and follow-through of each case. Working closely with State agencies to facilitate case approval, filing appeals as necessary. Contacting patient’s employer HR department and/or insurance company to gain knowledge on insurance fee structure Secures all required forms and data for the program, develops working relationship with MECS Director, Social Workers and Case Management, PA Directors as needed to communicate progress on the application status as well challenges with the case and how it may affect the payor outcome. Understanding of revenue reclassification Follows up on all assigned inventory timely according to documentation and follow-up guidelines. Documents thoroughly, applies all necessary codes to ensure accounts are captured correctly through our reporting. Once approval is obtained ensures coordination of benefits are correctly documented and verified Works closely with management team to continue the development of the program KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Working familiarity with the rules and regulations pertaining to Federal, State and County programs P/C systems literate including Windows, and Micorsoft Outlook, Excel and Word programs Ability to work independently Excellent oral and written communication skills, as well as the clear understanding of the English language Detail oriented, with strengths in dealing with multiple facilites, Supervisors, and Hospital platforms Ability to prioritize and manage multiple tasks with efficiency Valid Drivers License and auto insurance Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

Requirements

Working familiarity with the rules and regulations pertaining to Federal, State and County programs
P/C systems literate including Windows, and Micorsoft Outlook, Excel and Word programs
Ability to work independently
Excellent oral and written communication skills, as well as the clear understanding of the English language
Detail oriented, with strengths in dealing with multiple facilites, Supervisors, and Hospital platforms
Ability to prioritize and manage multiple tasks with efficiency
Valid Drivers License and auto insurance
High School Diploma or equivalent
Minimum 2 years of work experience in the medical field
Knowledge of Medical terminology
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

Responsibilities

Identifying candidates for the Health Insurance Premium Payment (HIPP) program
Assisting with enrollment
Working closely with family and the agency through the enrollment process
Identifying all sources for payment
Documenting accounting system including progress notes and all required activities to ensure accurate reporting
Following the case through the approval process
Working closely with the EES onsite teams to coordinate the patient’s application process
Performing an in-depth analysis of all inventory identified as eligible
Developing a working relationship with patient and/or family through application process for completion and follow-through of each case
Working closely with State agencies to facilitate case approval, filing appeals as necessary
Contacting patient’s employer HR department and/or insurance company to gain knowledge on insurance fee structure
Securing all required forms and data for the program
Developing working relationship with MECS Director, Social Workers and Case Management, PA Directors as needed to communicate progress on the application status as well challenges with the case and how it may affect the payor outcome
Understanding of revenue reclassification
Following up on all assigned inventory timely according to documentation and follow-up guidelines
Documenting thoroughly, applies all necessary codes to ensure accounts are captured correctly through our reporting
Ensuring coordination of benefits are correctly documented and verified
Working closely with management team to continue the development of the program