Insurance Specialist

Edgewood Surgical Center•Pymatuning Township, PA

8d•Onsite

About The Position

The Insurance Specialist verifies patient insurance coverage, benefits, eligibility, and authorization requirements before scheduled procedures and services. The role reviews patient accounts to estimate financial responsibility and contacts patients to explain coverage, discuss costs, answer questions, and collect deposits, copayments, or other pre-service payments. The specialist may also assist with registration, admissions, and check-in and serves as a liaison among patients, physician offices, insurance carriers, and hospital departments to obtain accurate financial and demographic information. The role documents verification activity, patient conversations, and payment arrangements in hospital systems; follows up on pending verifications and authorizations; and helps resolve registration errors and coverage discrepancies. The Insurance Specialist supports revenue cycle goals and department workflow, maintains current knowledge of insurance and reimbursement requirements, and protects confidential patient and financial information in accordance with HIPAA and hospital policies. Work takes place in person in a normal office and patient care environment, with possible exposure to communicable diseases, bloodborne pathogens, and other healthcare hazards.

Requirements

High school diploma or GED required.
Strong oral and written communication skills, with the ability to communicate effectively with patients, physicians, insurance companies, and hospital personnel.
Knowledge of medical terminology, insurance terminology, and healthcare reimbursement processes.
Strong customer service and patient relations skills.
Good planning, organizational, and time management skills.
Ability to work accurately with attention to detail.
Ability to maintain confidentiality and exercise discretion when handling sensitive information.
Ability to work under pressure and manage multiple priorities.
Ability to work effectively with others and independently with minimal supervision.
Professional approach to work and a strong sense of responsibility for assigned duties.
Physical ability to spend a medium percentage of time sitting, with occasional standing and walking; lifting requirements are generally light.
Ability to complete required hospital training programs.

Nice To Haves

Associate degree in Business, Healthcare Administration, Medical Office Administration, or a related field.
Working knowledge of Medicare, Medicaid, managed care, and commercial insurance plans.
At least three years of medical office, registration, insurance verification, patient access, billing, or revenue cycle experience.
Continuing education relevant to practice areas.

Responsibilities

Verify insurance eligibility, benefits, coverage, authorizations, and patient financial responsibility for scheduled procedures and services before the date of service.
Review patient accounts to determine copayments, deductibles, coinsurance, and estimated balances.
Contact patients to explain financial obligations and collect required deposits, copayments, and pre-service payments.
Explain insurance benefits and coverage and answer questions about billing, payment arrangements, and financial policies.
Assist with patient registration, admissions, check-in, and completion of registration and financial forms as needed.
Coordinate with physician offices regarding referrals, authorizations, and required insurance documentation.
Communicate with insurance carriers to verify coverage, obtain benefit information, and resolve eligibility discrepancies.
Identify accounts requiring authorizations or referrals and follow procedures to obtain approvals.
Accurately document insurance verification, patient conversations, and payment arrangements in hospital systems.
Monitor and follow up on pending insurance verifications and authorizations.
Maintain knowledge of insurance plans, payer requirements, Medicare, Medicaid, and commercial insurance guidelines.
Protect confidential patient information in accordance with HIPAA and hospital policies.
Answer telephone inquiries and direct calls to appropriate personnel when necessary.
Maintain effective working relationships with patients, physicians, insurance representatives, hospital staff, and others.
Comply with work-related policies, procedures, safety plans, and regulatory standards; use time, equipment, supplies, and other resources efficiently.
Assess and improve department performance and workflow efficiency.
Maintain skills and current knowledge relevant to new technology, billing regulations, payer requirements, insurance regulations, reimbursement requirements, and procedures.
Assist in identifying and resolving insurance-related registration errors and coverage discrepancies.
Support revenue cycle goals through timely verification and collection activities.
Help patients understand payment options and financial assistance resources.
Participate in departmental meetings, education programs, and performance improvement initiatives.
Support Edgewood Surgical Hospital's ethical and compliance principles in daily activities.
Complete relevant continuing education activities and required hospital training programs.
Perform other incidental tasks as needed.