Insurance Specialist (TEMP)

Cape Cod Healthcare•Hyannis, MA

About The Position

Responds to incoming calls regarding insurance authorizations, information requests, and denials. Regularly updates knowledge of third party payor regulations, and updates staff in writing of any changes as they become known. Verifies insurance pre-authorization/certification for services, including number of visits approved and dates that services are covered. Accurately completes insurance tracking sheet for each patient and each discipline. Tracks insurance caps and ensures that patient treatment does not exceed monetary allowance as outlined by insurance company; notifies patient and therapist of insurance caps. Acts as liaison between patients and clinicians regarding authorization and usage of visits. Follows through on requests for information within 24 hours Recognizes referral errors and makes corrections as needed. Compiles and submits appeal letters on receipt of denial. Obtains and submits information to resolve denials. Consistently ensures documentation received for extension approvals are in the medical record on the date received and communicated to the patient to ensure no interruption in care. ·Provide accurate and comprehensive information about all third party payors and requirements for authorized visits. Performs the basic duties of the Rehab Department secretary to cover brief absences. Communicate clearly and tactfully with patients and their families, maintaining confidentiality at all times. Attends departmental meetings as required. Acts as a resource and support person for front office staff. Perform other work related duties as assigned or requested. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital's commitment to CARES: compassion, accountability, respect, excellence and service.

Requirements

Ability to read, write and communicate in English.
High school graduate or equivalent.
Two years experience in a medical or rehab office, clinic, or comparable hospital experience utilizing insurance company websites required.
1 year experience working with third party payors including referral and authorization requirements.
Successful passage of basic medical terminology course OR successful passage of the CCH Medical Terminology exam.
Keyboarding skills at 35 WPM as demonstrated by successful passage of a timed test.
1 year experience with hospital, clinical or medical office based information system.
Basic mathematics skills and ability to apply skills, as demonstrated by successful passage of a timed business math test, using manual and aided computations to solve problems.

Responsibilities

Responds to incoming calls regarding insurance authorizations, information requests, and denials.
Regularly updates knowledge of third party payor regulations, and updates staff in writing of any changes as they become known.
Verifies insurance pre-authorization/certification for services, including number of visits approved and dates that services are covered.
Accurately completes insurance tracking sheet for each patient and each discipline.
Tracks insurance caps and ensures that patient treatment does not exceed monetary allowance as outlined by insurance company; notifies patient and therapist of insurance caps.
Acts as liaison between patients and clinicians regarding authorization and usage of visits.
Follows through on requests for information within 24 hours
Recognizes referral errors and makes corrections as needed.
Compiles and submits appeal letters on receipt of denial.
Obtains and submits information to resolve denials.
Consistently ensures documentation received for extension approvals are in the medical record on the date received and communicated to the patient to ensure no interruption in care.
Provide accurate and comprehensive information about all third party payors and requirements for authorized visits.
Performs the basic duties of the Rehab Department secretary to cover brief absences.
Communicate clearly and tactfully with patients and their families, maintaining confidentiality at all times.
Attends departmental meetings as required.
Acts as a resource and support person for front office staff.
Perform other work related duties as assigned or requested.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital's commitment to CARES: compassion, accountability, respect, excellence and service.