Avera Health is an integrated health system dedicated to providing top-quality healthcare services to residents of South Dakota and surrounding areas in North D
Insurance Specialist
Location
United States
Posted
2 days ago
Salary
$20 - $26 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Insurance Specialist
Avera Health
Role Description Responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. - Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers. - Confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. - Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. - Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care. - Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers. - Collect and validate accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information. - Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator. - Educate patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered. - Identify patients in need of financial assistance and provide charity applications and referrals to the business office as necessary. - Screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. - Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff. - Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations. Qualifications - 1-3 years related experience in billing, insurance or registration. - 1-3 years healthcare experience. Requirements - The individual must be able to work the hours specified. - Must have visual acuity adequate to perform position duties. - Ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. Company Description Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.
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