Insurance Specialist

Avera•Aberdeen, SD

22h•Remote

About The Position

The Insurance Specialist ensures insurance eligibility, benefit verification, and authorization processes are completed within payer deadlines to help prevent denials or penalties and optimize reimbursement from payers and patients. The role documents accurate insurance and authorization information and maintains working knowledge of insurance plans, contract requirements, and available resources. The Specialist interprets benefits and patient liabilities across payer types, including copays, coinsurance, and out-of-pocket responsibilities. They estimate and explain patient financial responsibility, provide charity applications or direct patients to the business office for payment and assistance options, and seek payment of patient liability before services and prior balances. The role collaborates with other departments to support appropriate reimbursement, completes transactions and government regulatory forms accurately, and complies with applicable regulations, including EMTALA and HIPAA.

Requirements

1–3 years of related experience in billing, insurance, or registration.
1–3 years of healthcare experience.
Ability to work the specified hours.
Visual acuity adequate to perform position duties.
Ability to communicate effectively, hear, understand, and distinguish speech and other sounds.
Ability to perform the essential job functions satisfactorily, with reasonable accommodations where applicable.

Nice To Haves

Associate degree in finance, business, or healthcare.

Responsibilities

Process insurance eligibility and obtain complete benefit information, including COBRA information when applicable; verify demographic information and ensure coordination-of-benefits and insurance plan codes are accurate.
Immediately verify coverage for same-day and next-day inpatient and outpatient add-on accounts.
Identify payment sources, primary and secondary coverage, and required authorizations to help prevent denials or payment reductions.
Obtain required referrals, authorizations, and pre-certifications from primary care or specialty physicians and enter the information into the health information system.
Collect and validate patient demographic and insurance information, verify coverage, obtain required pre-certifications or authorizations, and enter necessary information.
Calculate and communicate estimates for hospital services using a deposit matrix or patient payment estimator.
Educate patients about benefits and financial expectations, offer the opportunity to pay estimated responsibility before services, and explain available payment methods.
Identify patients needing financial assistance and provide charity applications or referrals to the business office.
Screen self-pay patients for potential payer coverage and refer applicable accounts to the advocacy team for further review.
Ensure payer requirements are met, including non-coverage waivers, Advance Beneficiary Notices, sterilization forms, and other applicable forms.
Communicate insurance coverage changes before billing with Registration staff and/or Patient Advocate or Billing staff.
Attend workshops, in-services, and webinars to maintain professional knowledge of insurance rules, regulations, and industry changes.
Maintain confidentiality and coordinate workflow effectively with team members.