Commercial Insurance Specialist
Brown & Brown Insurance
Insurance Verification Specialist
Boston Medical Center (BMC)
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Junior
About the role
- Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines
- Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance
- Acts as subject matter experts in navigating both the BMC and payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the scheduled care to proceed
- Supports BMC staff at all levels for hands-on help understanding and navigating financial clearance issues
- Obtains and clearly documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment
- Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients and any other parties to ensure that required managed care referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments/visits prior to scheduled patient visits or retro-actively if not in place at the time of the appointment/visit
- Ensure that approval numbers are appropriately linked to the relevant patient appointment/visit
- When it is determined that a valid referral does not exist, utilize computer-based tools or contact the appropriate party to obtain/generate referral/authorization and related information
- Collaborate with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services
- Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations
- Escalates accounts that have been denied or will not be financially cleared as outlined by department policy
- Maintain patient confidentiality, including but not limited to, compliance with HIPAA
- Attend all necessary hospital and department training as required
- Perform other related duties as assigned or required
Requirements
- High School Diploma or GED required, Associates degree or higher preferred
- 1-3 years Hospital registration and/or Insurance experience desirable
- At least one year of experience must be in a customer service role
- General knowledge of healthcare terminology and CPT-ICD10 codes
- Complete understanding of insurance is preferred
- Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues
- Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers
- Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail
- Knowledge of and experience within Epic is preferred
- Ability to effectively handle challenging situations and to balance multiple priorities
- Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom
Benefits
- Health insurance
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
hospital registrationinsurance experiencecustomer servicehealthcare terminologyCPT-ICD10 codesfinancial clearanceprior authorizationsreferralspatient confidentialitydecision making
Soft skills
interpersonal skillsjudgmentindependent thinkingcreativityattention to detailability to handle challenging situationsability to balance multiple prioritieseffective communicationcollaborationproblem-solving
Certifications
High School DiplomaGEDAssociates degree
