Insurance Specialist

📋 Description

• • **Join Avera and Move Health Forward as an Insurance Specialist!**
• • Are you a detail-oriented professional with a knack for navigating the complexities of insurance? Do you thrive in a role where accuracy directly impacts patient care and organizational revenue? Avera Health is seeking a dedicated Insurance Specialist to become an integral part of our compassionate, multidisciplinary team. In this vital role, you will be at the forefront of ensuring seamless financial processes for our patients, contributing directly to our mission of Moving Health Forward.
• • *Your Impact and Responsibilities:**
• • As an Insurance Specialist at Avera, you will be entrusted with the critical responsibility of managing the entire insurance lifecycle for patient accounts. This includes meticulously verifying insurance eligibility, confirming comprehensive benefit coverage, and securing necessary authorizations before services are rendered. Your diligence in these areas is paramount to preventing claim denials and avoiding financial penalties, thereby optimizing reimbursement for both Avera and our patients.
• • **Eligibility and Benefit Verification:** You will proactively engage with insurance companies and employers to confirm patient eligibility and secure complete benefit coverage details. This involves accurately identifying primary and secondary payers, confirming coordination of benefits (COB), and ensuring all demographic and insurance plan codes are precise. For same-day and next-day inpatient and outpatient admissions, you will prioritize immediate insurance coverage verification to expedite the admission process.
• • **Authorization and Pre-Certification Management:** A key aspect of your role will be obtaining all required referrals, authorizations, and pre-certifications from Primary Care Physicians, Specialty Physicians, Managed Care organizations, and traditional Medicaid programs. You will meticulously enter this crucial information into our health information system, ensuring compliance with payer requirements to prevent payment reductions or denials.
• • **Financial Counseling and Patient Responsibility:** You will play a crucial role in financial transparency by calculating and communicating estimated patient liabilities. Utilizing our deposit matrix or patient payment estimator tools, you will clearly explain copays, coinsurance, and out-of-pocket responsibilities. This involves educating patients and their families about their benefits and financial obligations, offering them the opportunity to settle estimated responsibilities prior to service, and identifying available payment methods.
• • **Revenue Cycle Optimization:** Your expertise will directly contribute to Avera's financial health. By ensuring accurate insurance information, obtaining necessary authorizations, and proactively identifying patient liability, you will minimize claim denials and accelerate the reimbursement cycle. You will also be responsible for collecting patient liability prior to service and attempting to collect outstanding prior balances.
• • **Collaboration and Communication:** This role requires strong collaboration with various internal departments, including Registration, Patient Advocates, and Billing staff. You will serve as a key communication link, ensuring that changes in insurance coverage are promptly reported and addressed before billing occurs. Your ability to foster positive working relationships across departments is essential for a smooth and efficient workflow.
• • **Compliance and Regulatory Adherence:** You will maintain a strong working knowledge of government regulations, including EMTALA and HIPAA, as they pertain to the insurance verification and authorization process. You will also ensure that all payer-specific requirements are met, including the accurate completion of non-coverage waivers, Advance Beneficiary Notices (ABNs), sterilization forms, and other necessary documentation.
• • **Financial Assistance and Self-Pay Management:** You will identify patients who may qualify for financial assistance programs. This includes providing charity applications and directing patients to the business office for further support and options. Furthermore, you will screen all self-pay patients for potential payer coverage and refer applicable accounts to the advocacy team for in-depth review.
• • **Continuous Professional Development:** To stay ahead in this dynamic field, you will be encouraged to pursue ongoing professional development. This includes attending workshops, in-service training sessions, and webinars to remain current with evolving insurance rules, regulations, and industry best practices.
• • **Teamwork and Professionalism:** You will embody Avera's commitment to compassion, hospitality, and stewardship. This means upholding our CARE standards (Communication, Attitude, Responsiveness, and Engagement) with enthusiasm and sincerity, maintaining confidentiality, and working effectively within a team environment to ensure a productive and efficient operation. You will also adhere to all safety principles, laws, regulations, and standards associated with CMS, The Joint Commission, DHHS, and OSHA.
• • At Avera, we believe that the way you are treated as an employee directly translates into the compassionate care you deliver. Join us in a ministry of healthcare where you can live out your faith, uphold the dignity and respect of all persons, and contribute to high-quality services that make a positive impact on moving health forward.
• • This position offers a competitive pay range of $19.50 - $25.50 per hour, dependent upon experience, and is a Regular, Day Shift role within Avera Health.