Insurance Authorization Specialist Ii (Remote)

Full time

Remote Work Opportunity

Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service for Trinity Health. Responsible for complex, high dollar services including surgical, observation and in-house services. Performs work in the multiple areas of verification: Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification or Scheduling and is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization, and preservice collections. This is a key position that begins the overall patient experience and initiates the billing process for any services provided by the hospital.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

Responsible for financially clearing patients for each visit type, admit type and area of service via current HIS (Health Information System). Collects and documents all required demographic and financial information. Activates registration and discharges in an appropriate and timely fashion.

Coordinates with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.

Coordinates with OR Scheduling on date of service changes and/or other revisions or cancellations and processes accordingly.

Analyzes patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order. Applies recurring visit processing according to protocol.

Verifies patient information with third party payers. Collects insurance referrals and documents within HIS. Communicates with patients and physician/offices regarding authorization/referral requirements. Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary. Escalates accounts appropriately in accordance with department Defer/Delay policy to manager.

Screens outpatient visits for medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients. Provides cost estimates. Collects and documents Medicare Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third party payers need to be billed (i.e., worker's compensation, motor vehicle accidents and any other applicable payer).

Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans. Ensures Meaningful Use requirements are met as appropriate.

Screens all patients self-pay & out of network patients using approved technology. Provides information for follow up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate. Initiates payment plans and obtains payment. Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. Incorporates point of service (POS) collection processes into daily functions.

May issue receipts and complete cash balance sheets in specified areas where appropriate. Utilizes audits and controls to manage cash accurately and safely.

Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection, and standards for registrations/insurance verification

Coordinates timely and accurate appointment scheduling across the region with expertise in scheduling protocols, insurance requirements and accurate collection and verification of pre-registration needs on an as needed basis

Communicates and promptly escalates accounts of concern to management.

Must possess the ability to comply with Trinity Health policies and procedures. Must be comfortable operating in a collaborative, shared leadership environment

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Other duties as assigned by manager.

MINIMUM QUALIFICATIONS

High School Diploma or equivalent combination of education and experience.

Must possess a comprehensive knowledge of financial clearance and insurance verification processes with three (3) years of financial clearance experience in an acute care setting.

Experienced in processing financial clearance for complex services including surgical services, observation, and in-house cases.

Strong knowledge in third-party and government payer billing and reimbursement guidelines as well as department performance standards and policies and procedures.

National certification in HFMA CRCR and/or NAHAM CHAA within one (1) year of hire.

Ability to communicate and work with patients, physicians, physician office personnel, associates, multiple direct patient care providers and others in order to expedite the registration/intake process.

Superior customer service skills and etiquette is strongly preferred. Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems. Must be proficient in the use of Microsoft Office business software

Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

This position operates remote in an in-home environment or in an onsite typical office environment. The area is well lit, temperature controlled and free from hazards.

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.

Must possess the ability to comply with Trinity Health policies and procedures.

Hourly pay range: $18.0229 – $27.0010

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.