Insurance Mgmt Specialist I- Full Time, Days, Morristown NJ

Atlantic Health System•Morristown, NJ

2h•$24 - $40•Onsite

About The Position

The Insurance Management Specialist I is responsible for verifying patient insurance for all incoming referrals and during the course of treatment. This role acts as a liaison between external insurance companies and internal staff to ensure patient needs are met and financial information is accurate. The specialist will obtain initial and ongoing precertification and authorization for services, document all verification and authorization information in EPIC, and manage assigned work queues to ensure timely completion. This position also supports data integrity by running reports and correcting inaccuracies, and participates in the EVV process as directed. The role is part of the Home Care and Hospice teams, working to provide comprehensive services to patients and their families.

Requirements

Verifies patient insurance for all incoming referrals for all payers.
Verifies patient insurance during course of episode if payer change occurs or a need for re-verification arises.
Documents all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results.
Obtains timely initial precertification and authorization for initial services when required.
Understands and enters pending authorization as required.
Demonstrated knowledge of payors and required documentation for precertification and authorization.
Obtains timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements.
Documents all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization.
Reviews 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.
Ensures coverage of department for assigned hours of operations.
Manages assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion.
Supports data integrity by running or working reports to identify and correct areas of inaccuracy.
Participates 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.
Participates as directed by Supervisor of Verification/Authorization in the EVV process.

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 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.
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