Insurance Specialist - Center for Fetal Diagnosis and Treatment

Children’s Hospital of Philadelphia•Philadelphia, PA

9h•Onsite

About The Position

This role will work in collaboration with clinical staff to standardize and streamline the verification and authorization process for patient referrals, including all possible visits, tests, procedures, and treatment plans for both new patients and second opinion referrals. It involves using patient records to access and document information supporting authorization and sharing critical information systematically. The specialist will network with other precertification/insurance employees across CHOP's billing entities to stay updated on changes and processes, and provide complete information to the Single Case Agreement Team for non-par insurance plans. They will also maintain and develop clear lines of communication with insurance representatives from multiple insurance companies to understand company-specific precertification/authorization guidelines. This role is expected to develop into a resource, mentor, and leader for other CHOP staff performing similar work, providing guidance and sharing knowledge regarding insurance authorization/intake/registration. The individual must effectively manage work across departments, work independently with minimal supervision, and participate in administrative decisions. Strong communication skills, attention to detail, and a high level of organization are critical qualities. The ideal candidate should have extensive knowledge of insurance plans, including out-of-network, Medicaid, and commercial plans, with experience in Maternal Fetal Medicine being a plus.

Requirements

High School Diploma / GED
At least five (5) years related healthcare registration, billing and/or reimbursement experience
Previous experience in complex clinical setting that required coordination of multiple services
Background in Medical Insurance
Advanced insurance authorization and registration techniques
Ability to provide training to staff in complexity of Insurance Authorization
High level of interpersonal skills with excellent customer service and responsiveness
Background in medical terminology
Strong Customer Service experience
Ability to multi-task and prioritize
Highly organized and dependable
Ability to prioritize and work on several projects at once while maintaining communication with all invested parties
Strong communication skills
Ability to work with stressful situations
Ability to function efficiently and professionally with minimum of supervision
Ability to quickly learn new procedures
Strong computer skills
Ability to juggle multiple insurance issues
Strong customer service skills
Ability to display compassion and empathy
Website Insurance Training (Navinet, WebMD, Passport)
EPIC training & testing (Prelude/Cadence)
Annual influenza vaccine (for employees who work in patient care buildings or who have patient facing responsibilities)

Nice To Haves

Associate's Degree
Bachelor's Degree
Experience in Maternal Fetal Medicine
Resource scheduling experience (e.g. ancillary testing)

Responsibilities

Responsible for verifying and authorizing the insurance of all new patients referred as well obtaining emergency authorization for scans/tests for all existing patients
Obtain authorization for all non par scans or procedures for all patients
Communicates directly with disease specialists and clinical staff regarding status of authorization and the need for clinical documentation
Verify coverage & benefit information via electronic eligibility or by contacting the payer
Document all relevant information into EPIC
Partners with Single Case Agreement Department to facilitate authorizations
Establishes process with Revenue Cycle to insure collection of payment, especially for non par insurance companies
Partners with Revenue Cycle and billing to collect any backlogged revenue
Educates families and clinical team regarding insurance coverage plans
Communicates with family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party
Respond to emails, answer calls, provide explanation of covered and non-covered services
Contacts appropriate clinical staff in timely manner with all information that requires follow-up
Develop and maintain systems to streamline communication with staff on all aspects of insurance
Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs and refer to FHCC when appropriate
Provides onsite training to scheduling, intake and registration staff with regard to insurance matters
Educates providers, intake coordinators and families on insurance issues
Assists in creating brochure which provides insurance information for families
Creates templates with correct CPT Codes for specific services for Single Case Agreement
Create and/or update patient record by verifying demographic, insurance information, or proper study identification in the registration system
Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payer plan entries for research and standard-of-care visits
Coordinate & communicate insurance issues with appropriate personnel (e.g. schedulers, Pre-cert dept, out-of -area dept, Self-Pay group, Single Case Agreement Team and PCP's staff when required
Educate and inform family of outstanding financial obligations if appropriate
Provide documentation in Guarantor's Notes in Epic
Electronically collect or facilitate payment of outstanding balances