Insurance Eligibility Specialist

2 weeks ago

Longview, Texas, United States Christus Health Full time

Overview:

The Insurance Verification Clerk plays a crucial role in ensuring that all scheduled and unscheduled patients have their insurance eligibility confirmed. This involves direct communication with insurance providers and the use of our advanced electronic eligibility systems. The position also entails analyzing eligibility data to estimate patient financial responsibilities based on their insurance agreements. Additionally, the clerk will handle pre-certification for patient visits when necessary and collaborate with Case Management for relevant clinical information.

Key Responsibilities:


• Assess each patient's insurance eligibility and benefits by verifying details with insurance companies, employers, or through our electronic systems, adhering to departmental protocols.

• Prioritize accounts based on coverage, service dates, and anticipated service costs.

• Confirm insurance details for both scheduled and unscheduled patients.

• Gather effective dates, accurate mailing addresses, pre-certification contact numbers, and meticulously document all findings in the system.

• Record any unique coverage details, including limitations, particularly for uninsured and high-risk accounts.

• Calculate amounts due, including deductibles and out-of-pocket expenses such as co-insurance and co-payments.

• Secure pre-certification for current visits from insurance providers and notify Case Management if clinical information is required for the pre-certification process.

• Communicate with pre-certification companies to obtain necessary reference numbers for hospital visits.

• Log pre-certification/reference numbers in the system.

• Acquire authorization for Medicaid patients when applicable.

• Refer accounts requiring clinical details to the Case Management Department.

• Adjust financial classifications and insurance plans to ensure accurate patient financial records.

• Identify and rectify any incorrect insurance plans or financial classifications in the system.

• Remove outdated or incorrect insurance plans from the system history.

• Update Medicaid plans to reflect the correct information.

• If insurance is confirmed as terminated, document all relevant information and transition accounts to self-pay status.

Qualifications:

Education/Skills:

  • High School Diploma or equivalent experience is required.

Experience:

  • 1 – 3 years of relevant experience is preferred.

Licenses, Registrations, or Certifications:

  • No specific licenses required.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

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