Insurance Specialist

Lifepoint Health • Pasco, WA

15h

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

Requirements

• High school diploma or equivalent - Required
• 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
• Working knowledge of managed care and third party payors

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.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees