Job Description

POSITION SUMMARY

The Insurance Benefit Specialist ensures all scheduled surgical cases have accurate, complete, and timely insurance verification, authorization, and financial documentation. This role directly supports clean claims, prevents denials, and ensures patients receive accurate financial estimates prior to their procedure. The Insurance Benefit Specialist may be cross-trained in other functions of the business office.

Role and Responsibilities

• Verifies all insurance information including authorizations, benefits coverage and claims mailing address and meticulously documents all data into HIS.
• Reviews and corrects all insurance information in the HIS. Including but not limited to any deductible, co-payment or patient payments that need to be collected at time of service.
• Informs Pre-admissions clerks at center and patients, when applicable, of any deductible, co-payment or patient payments.
• Works cooperatively with Scheduling Clerk and Pre-Admissions clerk for cancellations, additions and any changes to the schedule.
• Informs Pre-Admissions clerk of insurance benefits for determination of any co-payments and or deductibles that need to be collected.
• Communicates with any and every Adjuster, Nurse case manager and Benefits organizer for verifications and plan coverage.
• Collaborates with Revenue Cycle Manager on a daily basis.
• Works with Scheduling Clerk for accurate insurance information entry into the health information system.
• Collaborates with Scheduling Clerk for Insurance Authorizations, claim numbers and adjusters.
• Performs related work as required.
• Will cross-train to other Business Office positions for back up as needed.
• Reports directly to the Revenue Cycle Manager.
• Performs other tasks as assigned by the Revenue Cycle Manager.
• Must be willing to complete software training to keep up with advances in information technology.
• Represents the company in a thoughtful and professional manner to customers, i.e. facility administrators, business office personnel, clinical personnel, physicians, patients and vendors.
• Be familiar with the companies policy and procedures and HIPAA regulations.

Work experience

• Minimum of two years’ experience with Insurance benefits in an Ambulatory Surgery Center.
• GI experience required
• Experience using a medical software billing system. Must be familiar with Windows, Microsoft Office and ASC software.

Education Requirements

• High school graduate or equivalent.

Preferred Skills and knowledge

• Advantx or HST experience preferred.
• Must be able to work under pressure.
• Possesses excellent communication skills.
• Competence in oral and written skills.
• Ability to prioritize and complete tasks in a timely manner.
• Must possess the ability to perform multiple tasks simultaneously.
• Understanding of company products, services and customers.
• General understanding of the healthcare environment.
• Knowledge of alpha filing system.
• Ability to follow oral and written instructions.
• Ability to be cross-trained in other areas of the business office.
• Working knowledge of Medicare, Medicaid, Worker’s Compensation and Managed Care.
• Working knowledge Out of Network billing.
• Requires knowledge of medical terminology.
• Basic knowledge of codes and modifiers.
• Ability to access and utilize the Internet.
• Requires exposure to automated insurance verification applications generally used within the healthcare industry.

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