Insurance Specialist

Lifepoint Health•Pasco, WA

About The Position

The Insurance Specialist is responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures. Reports to: Patient Access Supervisor. FSLA: Non-exempt ESSENTIAL FUNCTIONS To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation. Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointment Heavy phone and payer website contact in accordance with payer pre-cert and verification regulations Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures. Maintains current knowledge of outpatient imaging policies and procedures Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure Works closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them. Creates and explains patient liability estimate for all scheduled and add-on procedures Contacts patient or physician offices when insurance information invalid or termed for all scheduled procedures Provides registration functions, as needed Performs other duties as assigned

Requirements

High school diploma or equivalent - Required
Working knowledge of managed care and third party payors
One year experience with obtaining and verifying pre-certifications with various insurance companies Required.
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
Must be able to work in a stressful environment and take appropriate action.
Must be able to function appropriately in a multi-task setting.

Nice To Haves

Two years of college or medical office specialist education - Preferred

Responsibilities

Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment
Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointment
Heavy phone and payer website contact in accordance with payer pre-cert and verification regulations
Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion
Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures.
Maintains current knowledge of outpatient imaging policies and procedures
Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems
Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure
Works closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them.
Creates and explains patient liability estimate for all scheduled and add-on procedures
Contacts patient or physician offices when insurance information invalid or termed for all scheduled procedures
Provides registration functions, as needed
Performs other duties as assigned

Benefits

Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and a minimum of 10 days of paid time off per year (for full time employees) as well as 8 paid holidays per year.
Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
Professional Development: Ongoing learning and career advancement opportunities.

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