Eligibility Insurance Specialist

Conifer Health Solutions•Harlingen, TX

8d•Onsite

About The Position

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. 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.

Requirements

High School Diploma or equivalent
Minimum 2 years of work experience in the medical field
Knowledge of Medical terminology
Working familiarity with the rules and regulations pertaining to Federal, State and County programs
P/C systems literate including Windows, and Microsoft 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 facilities, Supervisors, and Hospital platforms
Ability to prioritize and manage multiple tasks with efficiency
Valid Driver's License and auto insurance
Spanish Required

Nice To Haves

Spanish Required

Responsibilities

Performs an in-depth analysis of all inventory identified as eligible, including review of patient’s demographics, payor data, commercial vs. government payor structures, chronic illnesses, diagnosis, prognosis, and medical records.
Develops a working relationship with patients and/or families throughout the application process.
Works closely with State agencies to facilitate case approval and files appeals as necessary.
Contacts patient’s employer HR department and/or insurance company to understand insurance fee structure.
Secures all required forms and data for the program.
Develops working relationships with MECS Director, Social Workers, Case Management, and PA Directors to communicate application progress and challenges.
Follows up on assigned inventory timely according to documentation and follow-up guidelines.
Documents thoroughly and applies necessary codes for accurate reporting.
Ensures coordination of benefits are correctly documented and verified upon approval.
Works closely with the management team to develop the program.