Insurance Reimbursement Specialist
Description
Summary:
The Insurance Reimbursement Specialist is responsible for coordination and support of initiatives relative to the evaluation, processing, and handling of insurance verification/authorizations and patient benefits. Acts as a liaison between the insurance providers and agents, claimants, and policy holders regarding the status and eligibility for coverage for rehab services. This role is also an experienced back up to all other outpatient rehab support functions to include patient appointment scheduling, coverage of front desk, answering phones, checking in patients, and collecting co-pays.
Responsibilities:
1. Performs insurance eligibility verification/authorization and executes payor requirements as needed. Includes initiating eligibility transactions to obtain necessary billing information and authorization, referrals for service when appropriate.
2. Obtains and understands necessary clinical information (including diagnoses) to initiate requests for authorizations.
3. Ensures that proper selection of insurance, plan type, financial obligations, pre-certification and billing address are assigned in the system.
4. Communicates and updates all information in medical record pertaining to patient’s financial obligations to individual therapy sites, clinicians and billing office to ensure all therapy treatments are authorized. This includes but not limited to copayments, deductibles, self-pay rates, in-and-out of network responsibilities, referrals, authorizations and other information as needed.
5. Answers patient inquiries regarding their liability and able to explain variables involved and assists in mitigating any issues or barriers that may come up. Determines need for financial counseling and directs patient to appropriate Nuvance Health resources.
6. Collaborates with business office, clinical teams and patient for the denial and appeals process, as necessary.
7. Maintains communication with System departments (e.g., managed care, SBO, FCC) to identify any changes, trends, or updates to existing or new contracts the System may have with an insurance company.
8. Serves as back-up to other administrative functions as needed to include registering patients, scheduling patients, managing front desk operations (answering phones, collecting co-pays, etc..) and tracking plans of care.
9. Performs other duties as assigned
10. Ability to travel between outpatient sites, as assigned, based on coverage needs.
Other Information:
Experience with medical terminology, medical coding, billing procedures, medical records.
Basic knowledge of payor guidelines.
Working Conditions:
Manual: significant manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment: Generally pleasant working conditions
Company: Northern Dutchess Hospital
Org Unit: 1876
Department: Rehab Services Admin
Exempt: No
Salary Range: $18.39 - $34.14 Hourly