Outpatient Infusion Preservice Insurance Specialist Full Time

Trinity Health•Fresno, CA

2d•$23 - $31•Onsite

About The Position

This position works to support the goals of the Revenue Cycle and prevent avoidable denials through compliance with payer precertification and authorization requirements, interpretation of insurance benefits, patient liabilities and payer guidelines for commercial, managed care and government payers. In addition, the Preservice Insurance Specialist performs financial clearance and preregistration activity. This includes but is not limited to review and documentation of patient information, verification of treatment authorization, and interaction with the patient, their representative, the insurance company, physician office staff, Shared Service Center, other personnel as needed to obtain accurate and complete information.

Requirements

High school diploma or equivalent is required.
Extensive knowledge of medical terminology is required.
Working knowledge of DRG, CPT, APC and ICD-9-CM codes and the application of such as it applies to patient registration and precertification is required.
Comprehensive knowledge of Medicare, Medi-Cal, Commercial Insurance, Worker Compensation benefits is required.
Knowledge of clinical procedures, acuity and application to the population by gender and age is required.
Intermediate to advanced skills with Microsoft Office, scheduling applications, and ADT systems are required.
Effective oral and written communication skills, ability to work effectively as part of a team, a bias for action, adaptability to change and a willingness to take initiative on projects is required.

Nice To Haves

NAHAM certification preferred.

Responsibilities

Support the goals of the Revenue Cycle and prevent avoidable denials through compliance with payer precertification and authorization requirements.
Interpret insurance benefits, patient liabilities, and payer guidelines for commercial, managed care, and government payers.
Perform financial clearance and preregistration activities.
Review and document patient information.
Verify treatment authorization.
Interact with patients, their representatives, insurance companies, physician office staff, Shared Service Center, and other personnel as needed to obtain accurate and complete information.