Insurance Verification Specialist

3 weeks ago

Scarborough, United States New England Life Care Full time
Job DescriptionJob Description

New England Life Care (NELC) is one of the fastest growing home infusion therapy services companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 60 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.

New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, you may be the person we are looking for

New England Life Care is hiring a Full Time Insurance Verification Specialist to support our growth, who has experience, enjoys a fast-paced environment, and provides top-notch customer experience over the phone. If you have previous customer service and call center experience, this may be the position you have been looking for

This is a 100% remote, 40 hours per week position. Occasional holidays are also included in the schedule, but will be paid at a rate of 2.5 times the normal hourly rate. The normal schedule will be Sunday – Thursday 8:30 AM – 5:00 PM.

**Only hiring remotely in the following states: Maine, Massachusetts, New Hampshire, Connecticut, and Rhode Island**


Benefits:

  • Career Ladder
  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • Generous employer-matched 403b savings program
  • Company paid: Life insurance, Short- and long-term disability insurance
  • Paid Time Off
  • And much more

Job Responsibilities

  • Work with a team in a fast pasted environment to assist with onboarding new referrals coming from hospital, private practices, clinics, hospices etc.
  • Verifying all new patient referral’s insurance information (Commercial, Medicare, Medicaid, Work Compensation) and benefits to identify patient responsibility, authorization and coverage for home infusion therapies and communicate this information to the Intake team within 30 minutes.
  • Utilize online portals to identify plan benefits for home infusion.
  • Identify medical policies and medical necessity requirements to ensure timely payment of home infusion services.
  • Effectively negotiates with third party payers in a timely manner to establish pricing for prescribed services utilizing company guidelines.
  • Reverifies patient accounts each month to ensure that active patients have accurate insurance information available for billing purposes and follow up.
  • Enters new patient accounts into EMR accurately coding all required fields.
  • Utilizes EMR to comprehensively document all information related to patient accounts to ensure that status of account is current. Provides feedback to management as needed in areas that will maximize cash collection and minimize delays and unnecessary losses of revenue.
  • Communicates with branch personnel (via phone and e-mail) to review changes in therapy / patient status and completes edits and updates to billing account information as needed. Also notifies patients of changes in benefit levels and financial liability, if applicable. Follows up with case managers and third-party payers accordingly.
  • Tracks and trends internal and external issues that are affecting the timely and accurate processing of patient referrals and maintenance of a complete patient accounting database. Reports any adverse trends to supervisor in a timely manner.
  • Provide adequate follow up on accounts with any issues identified on claims/denials regarding current insurance status, i.e. coordination of benefits, termination of insurance, change of insurance, and communicate these issues to the patient.
  • Work daily reports that ensure account accuracy and smooth insurance billing process.

Required Qualifications / Skills

  • Associates Degree or Bachelor’s Degree in Business Administration preferred. Industry Certificates for job related topics are a plus.
  • A minimum of 2 years experience in healthcare provider’s business office or hospital setting, involved in the registration of patients, verification of Third-Party Insurance benefits required.
  • A minimum of 2 years experience with a third-party health insurance plan or plan administrator involved in coordinating health insurance claims preferred.
  • A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement preferred.
  • Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred.
  • Working knowledge of Home Infusion Therapy billing & collection preferred.

Preferred Skills:

  • Excellent communication (verbal and written) and interpersonal skills to interpret and explain policies and procedures and third-party insurance benefits to patients and their families.
  • Strong negotiation skills to secure favorable pricing agreements with insurance payers.
  • Demonstrated strong mathematic skills to calculate estimated charges, expected payments and co-pay balances.
  • Demonstrated ability to maintain confidentiality of patient information.
  • Excellent organizational skills with attention to detail.
  • Ability to work independently as well as part of a team.
  • Demonstrated ability to identify research and solve problems.
  • Ability to research and resolve problems independently; detail orientated.

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