Job Responsibilities : Insurance Specialist – Full Time – Days – Hybrid-Remote Opportunity
Salary : $53000 per year
Company : Henry Ford Health System
Location : Remote US
Educational requirements : High School
Under general supervision identifies and determines in accordance with established policies and procedures the accuracy and completeness of financial insurance and/or demographic information for patients receiving care HFHS. Accountable and responsible for all pre-admissions admissions and specified scheduled outpatient services rendered at HFHS. Investigates and reviews the accuracy and completeness of insurance information upon pre-admission and/or admission to ensure account is secure prior to discharge. Obtains benefit co-pay deductible and co-insurance information. Verifies insurance eligibility and benefit information and confirms that all insurance requirements are met including but not limited to referrals and authorizations. Resolves problem accounts to determine primary insurance and/or COB information.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
A variety of functions and responsibilities related to insurance verification and identifying authorization requirements prior to and/or after discharge of patient which includes:
- Research and review all insurance plans and confirms patient benefit eligibility including patient liabilities clauses riders and secondary payor information (coordination of benefits) via internal and external resources including contacting payor representatives as needed.
- Reviews and interprets insurance group pre-certification requirements. Ensures proper pre-authorizations have been obtained. Executes on-line operations for specific payors to complete the pre-certification process. Communicates data to HFHS Utilization Management Department for further medical review.
- Resolves discrepancies with the patient and/or family members employers and insurance companies to assist in obtaining insurance information. Interviews patients and/or family members; advises patient with regards to next steps or processes for securing financial coverage. Reviews and analyzes third party COB screen prior to billing to prevent claims rejection. Works with patient or family member regarding outstanding COB issues.
- Reviews analyzes and corrects COB discrepancies and other related issues to ensure the integrity of the insurance information is accurate prior to discharge.
- Handles insurance questions and/or obtains information from various HFHS areas including but not limited to clinics physicians patients attorneys employers and outside agencies via telephone or mail.
- Prepare and ensures account for accuracy in preparation for billing to third party payors utilizing several different arenas within HFHS computer system as well as other on line systems.
- Obtains referral from referring physician office prior to admission as required by the payor.
- Maintains status of all accounts pending verification reviews utilizing applicable work queues and takes appropriate action to resolve accounts.
- Represents HFHS to external agencies on issues involving workers compensation motor vehicle accidents and/or third party liability admissions and issues pertaining to financial policies and procedures.
- Performs functions necessary to secure referrals/authorizations on applicable encounters maintaining an appropriate lead-time as established by departmental guidelines.
- Responsible for referring accounts to the HFHS funding source vendor when an insurance cannot otherwise be secured.
Provides World Class Service Excellence to patients:
- Warm patient greeting and closing. (AIDET)
- Service Recovery (HEART)
- High Reliability (HRO) Quality standards
- Opportunity for to work from home after 2 – 4 weeks on the job with high performance metrics
- Casual in office attire
- Administrative workspace
- Standard work hours 8am – 430 pm no holidays weekends or evenings
- High school diploma or GED equivalent is required.
- Two (2) years of experience related to healthcare insurance eligibility insurance verification or insurance billing in a hospital/medical office setting.
- Knowledge of various insurance coverage COB rules of priority and processing procedures.
- Insurance payor systems experience required.
- EPIC training/experience preferred.
- ICD-10 medical terminology experience preferred.
- Ability to adjust to new technologies as introduced.
- Strong computer skills and working knowledge of Microsoft Office products.
- Ability to perform a variety of tasks in a fast-paced environment with frequent interruptions.
Under the leadership of President and CEO Wright L. Lassiter III Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals a health plan and 250+ sites
including medical centers walk-in and urgent care clinics pharmacy eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford the health system
now has 32000 employees and remains home to the 1900-member Henry Ford Medical Group one
of the nation’s oldest physician groups. An additional 2200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s
major academic medical centers receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses
pharmacists radiology and respiratory technicians. visit HenryFord.com.
Whether it’s offering a new medical option helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier it’s all about choice. Henry
Ford Health has a new approach for its employee benefits program – My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation benefits work/life balance
and learning – options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs an Employee Assistance Program
(Henry Ford Enhanced) Tuition Reimbursement Paid Time Off Employee Health and Wellness and a whole host of other benefits and services. Employee’s classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring advancement and fair treatment of all individuals without regard to
race color creed religion age sex national origin disability veteran status size height
weight marital status family status gender identity sexual orientation and genetic information
or any other protected status in accordance with applicable federal and state laws.