Insurance Specialist -Radiation Therapy

Reporting to the Manager of PFS works with patients and their representatives and insurance carriers and employer’s to determine patient benefits eligibility, pre-certify services and performs verification of benefits to ensure revenue reimbursement. Screens registration data for compliance with payer and pre-certification requirements, corrects and updates accounts and bills to the appropriate party.

1. Reviews and analyzes all required demographic, insurance/financial, and clinical data procured by patient intake and registration areas necessary to expedite payment on patient’s accounts. Resolves all issues including obtaining information and signatures on documents required by the patient’s insurance carrier. Corrects information in both the Patient Management System and Patient Account Systems. Interacts, via telephone and in person, with patients, their representatives, physicians, physician’s office staff, employers, and others, and reviews new and previously recorded patient, insurance and procedural information. Electronically records all phone interactions and records resolution to follow-up items in a timely manner. Communicates hospital policies to patients or their representatives. Follows, HIPAA, payer and applicable regulations and standards for registration and billing.
2. Performs pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payer requirements. Enters patient procedure insurance and benefits eligibility information into the hospital Patient Management and Patient Accounting computer systems. Ensures patient has coverage for procedure to be performed with a minimum standard set by Access Services Policy in advance of scheduled procedure. Acts as a liaison between patients and physicians with insurance companies to pre-certify all inpatient, outpatient and observation procedures/cases per insurance contract requirements. Notifies patients, physicians and ancillary departments regarding procedures that are potentially not covered and coordinates with Financial Counselors to initiate payment plan arrangements prior to patient services being rendered.
3. Researches pre-certification denials including missing authorization, patient pre-certification or referral documentation. Works on denied accounts with ancillary departments, physicians and reimbursement specialists to gather required information due to incorrect ID/group numbers, invalid insurance or filing deadline expirations to fulfill secondary payor requirements and successfully process denied accounts. Identifies, researches, and secures authorization for unspecified, new or unlisted procedures to procure payment from insurance carriers.
4. Utilizes Central Scheduling reports, reviewing specified physician ordered tests/ procedures ensuring the integrity of the registration and CPT codes match. Corrects Central Scheduling account errors and provides feedback regarding error trends to the Access Services Manager.
5. Documents number of days authorized by insurance carriers in the hospital computer system. Advises Patient Access Specialists and Case Managers on managed care and insurance requirements, researches and obtains written guidelines from carriers and researches issues to resolution with the Contract Management Team.
6. Serves as a team representative at NCH meetings and task forces providing input and recommendations on intake and registration issues with the patient’s need as priority. Researches and analyze case problems and participates in quality and process improvement initiatives as appropriate. Provides feedback into insurance carrier relationship ratings.
7. Adheres to all Northwest Community Hospital standards, policies, and procedures and reports compliance concerns to management staff.

1. High school diploma required. Associates degree or active pursuit of a degree preferred.
2. Minimum 2 years of customer service work experience using computers required.
3. Minimum of 2 years previous healthcare or related experience (i.e. billing, collections, insurance, and doctor’s office) and familiarity with payer requirements, regulatory compliance requirements, HIPAA privacy and security requirements, medical terminology and general revenue cycle procedures required. Prior revenue cycle work experience desired.

4. Ability to functionally navigate multiple computer software systems with accurate keyboard skills following computer security protocols.
5. The interpersonal communication skills necessary to interview and interact with customers, physicians and insurance carriers, to project a professional and compassionate concierge style of service.
6. Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, physicians and insurance carriers.
7. Detail oriented with good analytical problem-solving skills to appropriately register patients and schedule patient procedures.
8. Ability to operate routine office equipment (facsimile, copiers, plate production, scanners, printers).