Insurance Specialist (Full Time)

Overview

Responsible for verifying eligibility of benefits and obtaining insurance authorizations for all patients that receive care in the Physical Medicine and Rehabilitation outpatient departments. Works with provider’s offices on authorizations and denials as applicable. Performs charge and chart audits to ensure accurate billing and documentation. Supports the Scheduling/Financial Specialists when assistance is needed.

Why UnityPoint Health?

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.  

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.  Here are just a few:      

• Expect paid time off, parental leave, 401K matching and an employee recognition program.   

• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.  

• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.   

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.   

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. 

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities

Complex Scheduling and Registration

• Schedules complex, multi-discipline patient appointments.
• Monitors and completes accounts on multiple work queues in EPIC.
• Ensures patients have eligible and active insurance prior to scheduling and helps patients understand their coverage for services. Updates registration if coverage has changed and ensures account is accurate for correct and timely claims filing.
• Gathers billing information for patients with worker’s comp insurance (employer demographics, responsible billing party, billing address) and coordinates authorization for services.

Insurance Verification/Regulations

• Verifies eligibility and authorization needs of current and new patients for assigned departments.
• Maintains a working knowledge of relevant regulations affecting patients and the operation of our business.
• Assists in educating and acts as a resource to clinical and non-clinical staff related to coding and insurance regulations.
• Provides patient notification of insurance coverage and estimated responsibility, which may include coordination with Price-line and counseling patient on process for prompt pay and financial assistance applications.
• Accurately enters required information into EPIC account notes.

Pre-Authorizations

• Establishes effective rapport and works closely with clinical staff, doctor’s offices, patients and families to ensure that all patients have authorization for services.
• Initiates and coordinates prior authorization requests to third party payers and maintains a working knowledge of third-party payer guidelines. Follows up with third-party payers as necessary.
• Contacts patients and providers with authorizations or denials as applicable.
• Meets specified deadlines as required for continuity of ongoing patient care and patient satisfaction.

Accurate Billing

• Performs charge and documentation audits to ensure proper payment for assigned departments and compliance to insurance and government regulations. Correct charges and coding as needed.
• Runs revenue & usage reports to ensure timely billing and correct coding for patients served.
• Works with schedulers and clinical staff to improve processes and documentation to increase reimbursement and avoid denials.

Denials/Billing Issues

• Problem solves, analyzes and collaborates with patient, therapist, central billing office, revenue cycle department, and insurance companies to identify and resolve billing and denial issues, including sending appeals and trouble-shooting and correcting claim or account errors.
• Documents denials and billing issues to identify processes that need improvement in order to maximize efficiency and ensure proper payment within the department(s).
• Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.
• Handles next tier troubleshooting and escalations of billing and insurance concerns from patients, scheduling & billing specialists or providers.
• Establishes and maintains accurate files using word processing and spreadsheet documents.
• Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information related to billing/insurance/denials.

Qualifications

• High School/GED.
• Previous customer service experience. 
• Minimum of 1-year prior secretarial experience in medical environment. 
• Requires knowledge of commercial and worker’s compensation insurance.
• Knowledge of medical terminology. 
• Knowledge of medical billing and insurance. 
• Strong problem-solving skills. 
• Proficient in Microsoft office. 
• Demonstrate a professional image in dealing with the public, patients, families, payers and doctor’s offices.