Jr. Insurance Benefits Analyst (Remote Candidates Considered)

To financially clear all scheduled patients within 48 hours of their office visit and/or procedure. Resolve issues with accounts due to errors with authorizations, registration and eligibility. The job responsibilities include working effectively with the interdisciplinary team of Physician Offices, Insurance Companies, and CCHC Revenue Cycle to assure the protection and recovery of all revenues associated with services provided by MACC (Medical Affiliates of Cape Cod). Assists with the review, analysis, development, and implementation of Process Improvement changes for the department to improve efficiency and workflow.

DUTIES AND RESPONSIBILITIES:

• Obtain and verify authorizations to ensure payment for services provide through CCHC.
• Troubleshoot and evaluate work product of staff, make recommendations to management and assists with implementing changes.
• Utilizing the incoming referral work queue will request, obtain and link insurance referral authorizations to upcoming specialty appointments as outlined by the patient’s insurance plan in a timely manner.
• Work accounts in assigned work queues to resolve billing errors and edits to ensure all claims are filed in a timely manner.
• Work collaboratively with Patient Access Managers, Scheduling Managers, Business Office Managers, Vendors and Customers across the enterprise to ensure that Registrars and Schedulers are fully capable of using technology to properly register our patients.
• Follow-up and work registration/authorization claim denial work queues to identify and take the appropriate action to fix errors for claim resubmission to payers.
• Attend and participate in management meetings.
• Performs other job-related duties and assignments as requested/directed.
• Participate with management in strategizing for Process Improvement initiatives to improve cash flow.
• Ensure correct insurance company name, address, plan, and filing order are recorded in the patient accounting system.
• Utilize payer websites and/or Epic/Experian to process, obtain and verify insurance referrals.
• Verifying insurance eligibility using available technologies, payer websites, or by phone contact with third party payers. Working in accordance with required State and Federal regulations and CCHC policies.
• Assist Patient Access Managers with Quality Control assessments of their staff related to eligibility and pre-registration errors.
• Assists with review of financial clearance and registration procedures and ensure effective communication with physician practices, patients and internal departments.
• Responds to all practice inquiries and questions about insurances, referrals, and authorizations.
• Processes outgoing referrals to specialists outlined by the patient’s insurance plans in a timely manner.
• Work with department managers to continuously identify and correct issues identified by reporting.
• Demonstrates the ability to adjust to unexpected changes to assure all responsibilities/duties are met during absences or increases in work volume.
• Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.
• Track, document and communicate the status of referrals as they move through the referral process, ensuring proper follow-up, documentation and communication when the referral has been completed.
• Ability to work with minimum supervision and in a team environment.
• Assists management on special organizational projects for CCHC.
• Meets and maintains daily productivity and quality standards established in departmental policies.
• Assists the department, work unit and/or fellow staff members by cross-covering for absences, participating in special projects, and attending ongoing training sessions, etc.
• Contact patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
• Maintain core competency and current knowledge of regulatory payer authorization and eligibility requirements.
• Provide input and feedback for employee evaluations.
• Maintain close coordination with Practice Managers, Clinical/Front End staff, and Physicians to advise of any changes or updates to insurance payer requirements.

QUALIFICATIONS:

• Minimum of one (1) year experience in a large hospital’s Revenue Cycle Department with an emphasis on Patient Access and or Scheduling is strongly desired.
• Experience with large hospital information systems is required, preferably Epic and/or Siemens is preferred.
• Associate Degree strongly preferred, High School diploma or GED required
• Excellent interpersonal, problem solving and critical thinking skills
• Excellent PC skills with a strong emphasis on the Outlook suite of products
• Experience utilizing insurance payer websites preferred.
• Excellent verbal and written communication skills are required.
• Medical Terminology knowledge preferred

SCHEDULE DETAILS:

40 hours per week, Monday-Friday , Shifts: Five 8hr or Four 10hr, Possible Hybrid/Remote, No Weekends & No Holidays.