Filled- Insurance Mgmt Specialist I

Atlantic Health System•Morristown, NJ

63d•Onsite

About The Position

This role functions as a liaison between external Insurance Companies and internal staff to ensure patient needs are met. The specialist will verify patient insurance for all incoming referrals and during the course of treatment, participate in re-verification processes, and document all verification information in EPIC. Additionally, the role involves obtaining initial and ongoing precertification and authorization for services, understanding and entering pending authorizations, and demonstrating knowledge of payor requirements. The specialist will also manage assigned work queues, support data integrity, and participate in the EVV process. Other duties as assigned.

Requirements

High School Diploma or GED required.
Experience/knowledge in obtaining authorizations and familiarity with insurance verification is highly desirable.

Nice To Haves

A college degree is preferred.

Responsibilities

Function as a liaison between external Insurance Companies and internal staff to ensure patient needs are met.
Notify internal staff when patient updates are required.
Communicate with CAC & Clinical Teams to ensure required financial information is available to review with patient.
Communicate with Clinical Teams to request necessary information for ongoing authorizations in a timely manner.
Verify patient insurance for all incoming referrals for all payers.
Verify patient insurance during course of episode if payer change occurs or a need for re-verification arises.
Participate in the re-verification at designated times of year, i.e. open enrollment period.
Document all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results.
Obtain timely initial precertification and authorization for initial services when required.
Understand and enter pending authorization as required.
Demonstrate knowledge of payors and required documentation for precertification and authorization.
Obtain timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements.
Document all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization.
Review additional service request for completeness of information, accuracy and presence of required clinical data.
Request and /or submit clinical documentation for authorization/reauthorization in Epic, prepares updates as indicated.
Ensure coverage of department for assigned hours of operations.
Manage assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion.
Support data integrity by running or working reports to identify and correct areas of inaccuracy.
Participate as needed in the follow-up and correction of insurance and/or authorization information, including the process required for payer changes, or obtaining retro authorization.
Participate as directed by Supervisor of Verification/Authorization in the EVV process.
Perform other duties as assigned.

Benefits

Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)
Life & AD&D Insurance.
Short-Term and Long-Term Disability (with options to supplement)
403(b) Retirement Plan: Employer match, additional non-elective contribution
PTO & Paid Sick Leave
Tuition Assistance, Advancement & Academic Advising
Parental, Adoption, Surrogacy Leave
Backup and On-Site Childcare
Well-Being Rewards
Employee Assistance Program (EAP)
Fertility Benefits, Healthy Pregnancy Program
Flexible Spending & Commuter Accounts
Pet, Home & Auto, Identity Theft and Legal Insurance