Insurance Specialist I

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Responsible for the pre-verification of insurance for patients being admitted into the hospital for care. Ensures insurance coverage, resolves any issues with coverage and escalates complicated issues. Verifies, interprets, coordinates, disseminates insurance information; establishes and counsels patient on co-payments, maintains charge capture information.

1. Obtains pre-authorization approvals for outpatient procedures from the Surgery, Day Medicine, Radiology, Nuclear Medicine, Genetics, Sleep lab and Heart Station departments.

2. Preregisters, obtains prior authorization, price estimates, PCP referrals, upfront collections and referred accounts prior to date of service.

3. Obtains prior authorizations and insurance verification for all clinics, Medicare patients, out-of-state Medicaid, SDC and for specialty drugs.

4. Obtains the appropriate prior authorizations for surgical and outpatient procedures and the necessary CPT/ICD-10 diagnosis codes when appropriate.

5.Obtains price estimates, upfront collections and referred accounts prior to date of service.

6.Completes outbound calls to families regarding insurance coverage and benefits, high deductibles, co-pays, denials.

7. Conducts appropriate follow-ups and verifications on all assigned accounts including documenting in the patients account detailed insurance information prior to services being rendered.

8. Ensures that pre-certifications, pre-notifications, prior authorizations or referrals are received for each account with a financial class of insurance and/or Medicaid.

9. Appropriately refers all high dollar or self-pay accounts to Financial Counselor.

10. Serves as a liaison between the clinical staff and insurance payers.

11. Collects deductible, co-pay and all other applicable payments.

12. Performs other duties as assigned.