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Insurance Specialist

4 months ago

Granite City, United States Gateway Regional Medical Center Full time

We are Gateway Regional Medical Center. Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

  • Essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
  • Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
  • Comprehensive Employee Benefits: Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

  • Insurance Specialist is responsible for verifying insurance coverage, benefits and obtaining pre-certification, referral or authorization as needed per insurance company requirements for all in-patients and pre-scheduled outpatients.

    PRIMARY RESPONSIBILITIES

    • Maintains working knowledge of billing computer systems and insurance verification systems.
    • Verifies if pre-certification, referral or authorization is needed.
    • Obtains pre-certification, referral or authorization number if completed and updates patient file. If not completed, contacts physician's office to complete with clinical information. Notifies patient and hospital department if not completed by appointment date.
    • Informs Case Management of any in-patient insurance changes, out-of - network, poor or non-existing coverage, or when necessary.
    • Notifies patient, appropriate family members, physician and/or supervisor of network insurance coverage issues (as above) that may result in coverage reduction.
    • Notifies patients of co-payments, deductibles or deposits needed, when applicable. Documents in computer system.
    • Refers self-payment patients to manager /director or approved personnel for follow-up and possible referral to Medicaid Eligibility Program representative.
    • Maintains positive customer service at all times. Refers unresolved issues to appropriate supervisor / manager / director.
    • Attends departmental and other meetings as scheduled.
    • Maintains flexibility to work alternate shifts or positions as needed.
    • Performs other duties as assigned
    • Verifies insurance coverage and benefits by means of calling insurance company, using on-line Medicare, WebMD, Medicaid Envoy Systems or Internet insurance sites. Updates information on patients' record.
    • Scheduling
    • Pre-registration
    • Verification of insurance benefits
    • Authorization and referral to Medicaid Eligibility screening and/or Financial Counseling (if applicable.)
  • EDUCATION AND TRAINING
    • High school graduate or equivalent
    • Additional college or business training preferred.
    EXPERIENCE
    • Minimum of 2 years previous healthcare experience required
    SKILLS AND ABILITIES:
    • CPR is not required
    • Minimum typing skills of 35 wpm
    • Through knowledge of computer systems in healthcare information systems.
    • Knowledge of function and relationships with hospital environment preferred.
    • Proficiency in medical terminology
    • Working knowledge of insurance plans and requirements