Reimbursement Specialist - Insurance Verification; UTMC Program

Reimbursement Specialist
- Insurance Verification (UTMC Program)

JOB SUMMARY

• The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance.
• Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate.
• Specialist performs a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions.
• Will be required to work regular office hours at the designated facility.

JOB DUTIES/RESPONSIBILITIES

• Reviews the center's Commercial Notification Forms and returns an Insurance Verification Forms to the requesting staff within the designated program timeframe.
• Verifies insurance information is up to date for the next day's client roster and updates any applicable pop-ups in the system.
• For new clients, provides contact information, obtains client photo, updates the EMR with correct information and ensures the appropriate intake packet paperwork has been signed and verified to ensure clients’ understanding of policies.
• Prepares and updates the designated facility facesheets with insurance issues, patient responsibilities, outstanding balances, and any non-payment status changes for the next day and places them in HIPAA compliant blue folders for the appropriate providers.
• Analyzes designated eligibility reports on a daily basis.
• Communicates with and advises the Insurance Verification Team Leader of all problems related to insurance verification.
• Advises other departments of updated or new insurance information as needed.
• Adheres to all policies and procedures related to compliance with all federal and state billing regulations.
• Communicates with billing representatives regarding any insurance issues that may arise.
• Reviews and updates the Non-Payment status documents for both Med appointments and Therapy appointments.
• Maintains a positive and professional attitude.
• Reads all emails and responds accordingly in a timely manner.
• Listens to all voicemails and responds accordingly in a timely manner.
• Works with members of various teams and/or departments on identifying process improvements.
• Possesses flexibility to work overtime as dictated by department/organization needs.
• Communicates with clients regarding any benefit and/or billing questions they may have.
• Performs specified client benefit duties to ensure all required information is obtained for insurance verification, billing, and claims follow-up.
• Collects all client responsibility balances via cash, check, money order or credit card and issues receipts for payments.
• Assists in determining proper courses of action for successful resolution to insurance issues.
• Completes all program related paperwork required for reporting purposes.
• Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Reviews patient bills for accuracy and completeness and obtains any missing information.
• Sets up patient payment plans and works collection accounts.
• Submits monthly recommendations to supervisor for write-offs with complete documentation by the first of the following month, all while following the A/R Reference Guide on how to complete write offs.
• Performs additional duties as requested by Team Leads or Management Team.

JOB QUALIFICATIONS

• Advanced use of computer system software, Excel, Outlook and Microsoft (word processing and spreadsheet application).
• Knowledge of insurance guidelines for all Commercial, Medicare, Medicare Advantage, Tenn Care, Federal Medicaid and Private Pay financial classes.
• Exceptional customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Ability to work well in a team environment and alone.
• Ability to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion, and analyze and resolve claims issues and related problems.
• Strong written and verbal communication skills.
• Maintain patient confidentiality as per HIPAA.
• Maintain a good understanding of the state, federal, and payer guidelines on billings, collections, refunds, and over payments.
• Knowledge of the center's Policies and Procedures.
• Ability to maintain records and prepare reports and correspondence related to the position.
• Ability to work directly with upper leadership regarding claims issues and resolutions.
• Possess effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others.

COMPENSATION:

• Starting salary for this position is approximately $19.54/hr based on relevant experience and education.

Schedule:

• Monday
  - Friday 8am - 5pm

Travel
:

• N/A

Equipment/Technical Competency
:

• Advanced use of…