Insurance Eligibility Specialist

MemorialCare•Fountain Valley, CA

7d•Onsite

About The Position

The Insurance Eligibility Specialist is responsible for timely and accurate verification of medical insurance benefits for both admission and pre-admission visits. The Insurance Eligibility Specialist will obtain current eligibility, verify benefit coverage, and ensure accurate information is obtained (pre-certification, authorizations & tracking numbers) and documented into the registration system to secure reimbursement. The Insurance Eligibility Specialist must be knowledgeable with insurance contracts. Ability to work from work queues and assist with training new staff. Multi-task oriented with the ability to prioritize and coordinate the essential job functions. Maintains effective working relationships with coworkers, nurses, physicians, and other hospital staff members in order to insure workflow effectiveness. This position requires full understanding and active participation in fulfilling the mission of Memorial Care. It is expected that the employee demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion and Synergy. The employee shall support the MemorialCare Health Systems strategic plan and participate in and advocate performance improvement/patient safety activities.

Requirements

A minimum of 2 years in admitting/registration/insurance verification or equivalent healthcare experience preferred.
Knowledge of insurance and payors.
Ability to communicate effectively verbally and written.
Must have strong customer service and computer skills.
High school diploma or GED preferred
Medical terminology course preferred
Bilingual (English/Spanish) preferred
Must adhere to the MHS Time and Attendance policy, clocks "in" and "out" of MTM accurately with minimal manual clocking requests for each scheduled shift and must sign off on MTM by the end of each pay period.
Avoid HIPAA violations by accurately entering patient information into the system, adheres to policy of using 2 patient identifiers to avoid passing on defects such as, incorrect PCP, guarantor, IPA, health plan, subscriber, W/C, guarantor etc.
Has the appropriate level of expertise in EPIC, OnBase, RTE, contracts and websites to ensure accurate and efficient reimbursement.
Must possess the ability to multitask and perform multiple duties at a time due to the high patient volumes for MemorialCare Health Systems.

Nice To Haves

Medical terminology course preferred
Bilingual (English/Spanish) preferred

Responsibilities

Responsible for timely and accurate verification of medical insurance benefits for both admission and pre-admission visits.
Obtain current eligibility, verify benefit coverage, and ensure accurate information is obtained (pre-certification, authorizations & tracking numbers) and documented into the registration system to secure reimbursement.
Assist with training new staff.
Input accurate documentation into the registration system to secure reimbursement.
Ensure that all verification documentation is complete and scanned into EPIC timely.
Enter notes into referral or auth/cert workflow by following the Admitting department Standard Work regarding patient benefits, out of pocket lifetime max on benefits and effective dates of insurance eligibility.
Perform insurance eligibility timely and accurately.
Monitor/manage assigned EPIC work queues ensuring immediate bill release.
Responsible for meeting the department’s daily productivity requirements to maximize productivity by meeting the Admitting department weekly goals.
Create patient estimates accurately and timely.
Notify patients of estimate amount via phone and mailed letter.
Responsible for computing patient estimates and advises patients of their financial responsibility: including deposits, co-pays, deductibles, estimate’s and co-insurance timely and accurately.
Collects out of pocket financial liabilities from patients prior to scheduled services being rendered.
Obtain and assign the correct insurance plan code and IPA codes with minimal errors.
Multitask and perform multiple duties at a time due to the high patient volumes for MemorialCare Health Systems.
Other duties as assigned.