Insurance Specialist

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Job SummaryResponsibilities include case management for all commercial insurance , Medicare and Medicaid primarily for off-sites and OPD as needed.Essential Functions

• Advises patients of insurance coverage and potential out of pocket expenses
• Notifies clinical departments and patient accounts when insurance will no longer cover treatment.
• Responsible for following Medicare guidelines for outpatient rehabilitation for off-sites and OPD Medicare patients.
• Responsible for tracking when Medicare patients are close to exhausting their rehabilitation benefit.
• Distributing ABN’s to off-site and OPD Medicare patients when patients meet rehabilitation benefit limits.
• Responsible for following Medicaid guidelines for outpatient rehabilitation and obtaining daily authorizations for off-site and OPD Medicaid patients.
• Answer patient phone inquiries.
• Responsible for review of all Outpatient Business Office mail.
• Update Mediserve authorization file with authorizations.
• Schedules re-evaluation appointments for insurance follow-up
• Responsible for setting up and maintaining follow-up system for case managed accounts for initial and recurring authorization requests.
• Responsible for notifying patients if their carrier has not pre-authorized OPD services and advising patient of Burke payment policies.
• Contact patients to obtain updated prescriptions if necessary.
• Contact physician offices to obtain additional updated prescriptions if necessary.
• Responsible for follow-up calls to insurance companies on pending authorizations.
• Responsible for OPD case management as needed.
• Will provide back up coverage to schedulers in OPD as needed, and the satellites on an emergency basis.
• Any other duty as directed by Manager.
• Practices universal precautions.
• Demonstrates the ability to communicate with pediatric, adolescent, young adult and geriatric patients and visitors.
• Adheres to Service Excellence Standards by demonstrating positive communication, prompt & respectful service and maintaining an appropriate work environment when working with patients, staff, co-workers, visitors and others.
• Other duties as assigned.

Qualifications

• High School Diploma or GED Required
• 3-5 years in hospital setting (preferable outpatient), billing company, multi specialty doctor’s office or insurance company Required
• Individual must be computer literate, possess excellent organizational and customer service skills, detail oriented and able to multi task.
• Knowledge of medical terminology is required.
• Prior experience obtaining insurance authorizations or referrals is required.
• Computer experience required, preferably working with a scheduling system.
• Able to work independently and to meet insurance authorization expiration date deadlines.
• Must be able to communicate with tact and diplomacy.
• Takes initiative and be self-directed.

The Burke Rehabilitation Hospital is an equal employment opportunity employer. The Burke Rehabilitation Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.