Insurance Clearance Rep Sr

Advocate Health and Hospitals Corporation•Milwaukee, WI

1d•Remote

About The Position

The Insurance Clearance Representative Sr. is responsible for acquiring and maintaining current knowledge of all payor requirements related to patient/hospital responsibility for authorizations and hospital billing, including all Federal and State regulations. This role performs all insurance authorization of inpatient and outpatient services by accurately collecting and analyzing clinical data to support payor guidelines and submits accordingly. The representative uses resources to determine appropriate procedure codes for authorization to ensure appropriate reimbursement. They consult with patients and appropriate departments regarding uninsured status, uncovered services, out-of-network status, and situations where the only insurance is Third Party Liability or Workers Compensation, providing next steps. The role initiates communication to the patient when authorization is not obtained and explains potential financial responsibility. The Insurance Clearance Representative Sr. maintains knowledge of all stand-alone computer software programs to verify eligibility and authorization, and ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage. They identify at-risk balances related to Medicaid eligibility rules and communicate them to Financial Counseling, Utilization Management, and physicians. The role completes cancellations and accurately reschedules patients according to department procedures, manages incoming and outgoing calls to complete pre-registration with patients, and pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with specialized needs and preparing necessary documents/records when necessary. Ensures accurate entry of patient demographic and insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record, and authorization data. Generates and processes all required documents for completion of registration, providing detailed education to the patient on the documents and forms requiring patient signature. Participates in department staff meetings and keeps abreast of continuing education to ensure effective communication and to maintain skill competency. Seeks out education opportunities to increase knowledge in department procedures as it relates specifically to scheduling needs for that area. Attends all mandatory in-services 100% and completes all mandatory safety in-services and skill competencies as required. Actively participates in group projects to problem-solve department issues. Possesses operational knowledge of the various Advocate Aurora Health departments so that patient, visitor, and fellow employee questions are answered or referred in an appropriate manner. Maintains confidentiality of patient records by following HIPAA and all compliance policies and guidelines.

Requirements

High School Graduate.
Typically requires 2 years of experience in health care, insurance industry, call center, or customer service setting.
Ability to problem solve in a high profile and high stress area.
Ability to prioritize and organize workload.
Mathematical aptitude, effective communication, and critical thinking skills.
Understanding of basic human anatomy and medical terminology.
Excellent verbal and written communication skills.
General computer knowledge.

Responsibilities

Acquires and maintains current knowledge of all payor requirements as it relates to patient/hospital responsibility for authorizations and hospital billing, including all Federal and State regulations.
Performs all insurance authorization of inpatient and outpatient services, by accurately collecting and analyzing clinical data in support of payor guidelines and submits accordingly.
Uses resources to determine appropriate procedure codes for authorization to ensure appropriate reimbursement.
Consults with patient and appropriate departments for uninsured status, uncovered services, out of network status and situations where the only insurance is Third Party Liability or Workers Compensation and provides next steps.
Initiates communication to the patient when authorization is not obtained and explains the potential financial responsibility.
Maintains knowledge of all stand-alone computer software programs to verify eligibility and authorization.
Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage.
Identifies at risk balances related to Medicaid eligibility rules and communicates to Financial Counseling, Utilization Management, and physicians.
Completes cancelations and accurately reschedules patient according to department procedures.
Manages incoming and outgoing calls to complete pre-registration with patients.
Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with the specialized needs, and preparing necessary documents/records when necessary.
Ensures accurate entry of patient demographic and insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data.
Generates and processes all required documents for completion of registration, providing detailed education to the patient on the documents and forms requiring patient signature.
Participates in department staff meetings and keeps abreast of continuing education to ensure effective communication and to maintain skill competency.
Seeks out education opportunities to increase knowledge in department procedures as it relates specifically to scheduling needs for that area.
Attends all mandatory in-services 100% and completes all mandatory safety in-services and skill competencies as required.
Actively participates in group projects to problem solve department issues.
Operational knowledge of the various Advocate Aurora Health departments so that patient, visitor, and fellow employee questions are answered or referred in an appropriate manner.
Maintains confidentiality of patients records by following HIPAA and all compliance policies and guidelines.

Benefits

Comprehensive suite of Total Rewards
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program