NWIN Insurance Verification and Authorization Specialist, Full Time - Days
About The Position
Under the general supervision of the Patient Access Manager, the Insurance Verification and Authorization Specialist is responsible for successful financial clearance of scheduled patient services. The role collaborates with the Managed Care office to identify and interpret contracts governing patient care and respond to patient inquiries in a timely manner. Duties include securing authorizations and HMO referrals, verifying benefits, and completing timely admission notifications for bedded patients. The specialist uses customer service, communication, and critical-thinking skills to respond to patient and care-team inquiries and requests, and initiates problem-solving, referring escalated concerns to appropriate sources when needed. This full-time position is part of Patient Access at Crown Point and follows a Monday–Friday day schedule from 8:30 a.m. to 5:00 p.m. The work arrangement is hybrid remote, with onsite work required on certain days.
Requirements
- Associate degree in business, healthcare, or a related field, and/or at least 3 years of Revenue Cycle experience with working knowledge of insurance and benefits.
- At least 3 years of prior Epic experience.
- High degree of initiative and problem-solving ability.
- Ability to prioritize and accurately execute multiple tasks in a high-pressure environment.
- Ability to demonstrate and maintain strong customer service orientation and commitment to excellence in a changing environment.
- Excellent communication skills and ability to interact with people in a variety of contexts.
- Ability to respect patient confidentiality and interact with patients, families, and other customers with courtesy, tact, and discretion.
- Strong investment in a team-oriented environment, with the ability to work independently and make decisions in the best interests of patients and the hospitals.
- Willingness and ability to cooperate with coworkers, supervisors, and physicians to serve patients.
- Flexibility and willingness to learn and incorporate new systems and processes as technology advances.
Nice To Haves
- Knowledge of medical terminology; a certificate is a plus.
- Knowledge of diagnostic and CPT coding and guidelines.
- Knowledge of Microsoft Office applications.
Responsibilities
- Secure HMO referrals as necessary based on the plan and service before the date of service.
- Contact insurance companies by phone or portal to review benefits, determine authorization requirements, initiate authorizations, provide clinical information as needed, and follow up on authorization decisions.
- Serve as a liaison among providers, ancillary areas, utilization management, patient financial services, and other parties.
- Work collaboratively with managed care partners to ensure timely screening for Medicaid coverage.
- Document account activity accurately in the EMR to support financial clearance.
- Assist with assigned Epic work queues to correct account deficiencies in a timely manner for billing.
- Contact patients as needed to obtain additional information for accurate and timely billing.
- Complete admission notifications for bedded patients according to payer guidelines and department standards.
- Respond to patient and care-team inquiries and requests, resolve issues where possible, and refer escalated concerns to appropriate sources.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
