Insurance Verification Representative - Emerson Health (Concord, MA)

Huron Consulting Services•Boston, MA

13d•$19 - $25•Remote

About The Position

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. Join our team as the expert you are now and create your future. Emerson Health’s revenue cycle operations are jointly operated by Huron and Emerson Health. Huron provides strategic revenue cycle operations leaders (managers and above are employed by Huron), while revenue cycle associates and supervisors are badged and employed by Emerson Health. Emerson, like all other providers in the market, is under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Emerson Health, in collaboration with Huron, must empower leaders, clinicians, employees, affiliates, and communities to build a culture that fosters innovation to achieve the best outcomes for patients and succeed long-term. Learn more about Emerson Health here: https://www.emersonhospital.org/?utm_source=gmb&utm_medium=organic&utm_campaign=reputation&utm_content=listing Joining the Huron Managed Services team means you’ll help Emerson Health evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. The Pre-Service Financial Representative supports the Revenue Cycle by financially clearing urgent and/or elective cases. In addition to contacting payers and providers to secure authorizations and/or initiate notices of admission, the representative may be responsible for informing patients of payment requirements, alternative financing, or charity care programs. When required, this individual will relay information to patients in a friendly, clear manner to provide excellence excellent customer service. This role is a largely remote position supporting a virtual business office. As such, this role requires frequent and effective communication via phone, email, and instant messaging with the various engagement teams. Strong oral and written communication skills, analytical skills, ability to work independently, and be self-motivated are required. This position is remote but will require onsite training at Emerson Health's Concord, MA office for 1-3 months.

Requirements

Two years of appropriate work experience that would indicate a high level of communication skills and knowledge of the modern revenue cycle
Broad Knowledge of Government Programs and Insurance Regulations
US Work Authorization required
Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint)
Ability to pay close attention to details; strong follow-up and follow-through skills
Requires the use of independent judgment, discretion and decision making abilities
Ability to interact with internal and external customers in a professional manner
Ability to ramp up on a client’s environment, processes, historical context, and systems to provide support to an engagement as soon as possible
Demonstrates a solid understanding of and adheres to all Huron Healthcare compliance program requirements
May be requested to work overtime and/or weekends to fulfil client requirements

Responsibilities

Verifies patients’ insurance benefits and information, as well as obtains pre-authorizations from third party payers in accordance with payer requirements, and/or initiates notifications of admission
Resolves authorization denials by providing additional information, documentation, and appeals
Completes retro-authorizations for urgent and add-on cases as allowed by insurance providers
Documents all payer communications and pre-service financial conversations, including payor decisions, reference numbers, and representatives spoken to.
Informs provider offices of medical necessity fails. Provides ABN and Financial Liability form to offices for signage by patient before procedure DOS.
Completes notification of birth to MassHeath if mother is enrolled in Medicaid plan.
Notifies payors of inpatient and observation admissions via online portals, fax or phone.
Updates EMR system with approvals when received.
Communicates as needed with registration staff and financial counselors
Reports all identified compliance risks to appropriate leadership
Other duties and responsibilities as assigned