Jr Insurance Benefits Analyst

Cape Cod Healthcare•Hyannis, MA

11d

About The Position

This role involves troubleshooting and evaluating the work of staff, making recommendations to management, and assisting with implementing changes. The analyst will participate in management meetings, strategize for process improvement initiatives to enhance cash flow, and assist with special organizational projects. Key responsibilities include providing input for employee evaluations, collaborating with various managers and vendors to ensure technology is effectively used for patient registration, and reviewing financial clearance and registration procedures. The analyst will also work with managers to identify and correct reporting issues, assist with quality control assessments related to eligibility and pre-registration errors, and verify insurance eligibility using various technologies and direct contact with payers, adhering to state and federal regulations and company policies. Additionally, the role requires contacting patients for information, updating EMRs, ensuring accurate insurance details are recorded, processing outgoing referrals, and utilizing payer websites and internal systems to obtain and verify authorizations. The analyst will track and communicate referral statuses, maintain knowledge of regulatory requirements, obtain and verify authorizations for payment, and work assigned queues to resolve billing errors and claim denials. Close coordination with practice managers and staff regarding insurance requirements is essential, as is responding to practice inquiries. The position requires meeting daily productivity and quality standards, cross-covering for absences, participating in special projects and training, and performing other related duties as assigned. The ability to adjust to unexpected changes and work with minimum supervision in a team environment is also crucial.

Requirements

High school diploma or GED required
Experience with large hospital information systems is required, preferably Epic and/or Siemens is preferred.
Excellent interpersonal, problem solving and critical thinking skills
Excellent PC skills with a strong emphasis on the Outlook suite of products
Excellent verbal and written communication skills are required.
Ability to work with minimum supervision and in a team environment.

Nice To Haves

Associate Degree strongly preferred
Minimum of one (1) year experience in a large hospital’s Revenue Cycle Department with an emphasis on Patient Access and or Scheduling is strongly desired.
Medical Terminology knowledge preferred
Experience utilizing insurance payer websites preferred.

Responsibilities

Troubleshoot and evaluate work product of staff, make recommendations to management and assists with implementing changes.
Participate with management in strategizing for Process Improvement initiatives to improve cash flow.
Attend and participate in management meetings.
Assists management on special organizational projects for CCHC.
Provide input and feedback for employee evaluations.
Work collaboratively with Patient Access Managers, Scheduling Managers, Business Office Managers, Vendors and Customers across the enterprise to ensure that Registrars and Schedulers are fully capable of using technology to properly register our patients.
Assists with review of financial clearance and registration procedures and ensure effective communication with physician practices, patients and internal departments.
Work with department managers to continuously identify and correct issues identified by reporting.
Assist Patient Access Managers with Quality Control assessments of their staff related to eligibility and pre-registration errors.
Verifying insurance eligibility using available technologies, payer websites, or by phone contact with third party payers. Working in accordance with required State and Federal regulations and CCHC policies.
Contact patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
Ensure correct insurance company name, address, plan, and filing order are recorded in the patient accounting system.
Processes outgoing referrals to specialists outlined by the patient’s insurance plans in a timely manner.
Utilize payer websites and/or Epic/Experian to process, obtain and verify insurance referrals.
Utilizing the incoming referral work queue will request, obtain and link insurance referral authorizations to upcoming specialty appointments as outlined by the patient’s insurance plan in a timely manner.
Track, document and communicate the status of referrals as they move through the referral process, ensuring proper follow-up, documentation and communication when the referral has been completed.
Maintain core competency and current knowledge of regulatory payer authorization and eligibility requirements.
Obtain and verify authorizations to ensure payment for services provide through CCHC.
Work accounts in assigned work queues to resolve billing errors and edits to ensure all claims are filed in a timely manner.
Follow-up and work registration/authorization claim denial work queues to identify and take the appropriate action to fix errors for claim resubmission to payers.
Maintain close coordination with Practice Managers, Clinical/Front End staff, and Physicians to advise of any changes or updates to insurance payer requirements.
Responds to all practice inquiries and questions about insurances, referrals, and authorizations.
Meets and maintains daily productivity and quality standards established in departmental policies.
Assists the department, work unit and/or fellow staff members by cross-covering for absences, participating in special projects, and attending ongoing training sessions, etc.
Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.
Performs other job-related duties and assignments as requested/directed.
Demonstrates the ability to adjust to unexpected changes to assure all responsibilities/duties are met during absences or increases in work volume.