Insurance Specialist

Description Description of Duties: 1. Verify insurance on new intakes for all NAL locations - Effective date of insurance policy. - If recent effective date, is there a pre-existing or rider on policy? - Deductible, % of coverage (80/20, etc.). co-payment, co-insurance (e.g. % plus co-pay). - Out-of-pocket max (O.O.P.) - If a patient is on Medicare and another insurance, which is primary? - Claims mailing address - Check on required credentials—e.g. Rule 29, license. - Who is covered? Individual/family policy 2. Secure authorization/referral for all NAL locations - Obtain correct phone numbers for authorization/referrals - Obtain authorization/referral with number of sessions and effective date/expiration dates - Where to send O.T.R. (outpatient treatment reports) to 3. Complete intake form from authorizations from BHP - Call for insurance verification 4. Address/insurance updates (in update folder at front desk) - Pull charts for address changes and update MediSoft system - Pull charts for insurance changes and write new intake - Follow first two steps and copy Patient Account reps according to clinic team. 5. Intra-clinic referrals - Pull charts, verify insurance and provider eligibility with each insurance carrier. - Obtain necessary authorizations/referrals 6. Chart Duties - Solve billing problems with Billing department staff and insurance companies. - Make sure the next day charts are up-to-date re: insurance and authorization. Write co-pays on daily collection sheet. Paper clip to front of chart a blank PA’s (e.g. BHP) with basic information filled in re: patient’s name, D.O.B., authorization number, date of first appointment and how many times seen, what procedure codes are needed. Re-verify insurance every six (6) months, and once a month for MA patients. Put “Number-of-Visits” sticker on all M.D. charts. Do retro authorizations when needed. 7. Other duties - Pull charts to file authorization hard copies received in U.S. mail or fax. - Answer insurance questions from patients/clinicians for all NAL locations. - Keep “to be verified” and “already verified” file folders in date order. Re-verify benefits for all patients with commercial insurance every six (6) months and the benefits of MA patients every month. - Work on solving billing problems with insurance companies. - Check for and set-up new insurance sites for patient verification. - Maintain existing computer links with insurance companies. - Other department related duties as assigned by management.

Requirements Qualifications: - Experience: Minimum of two years working in health care facilities preferred, particularly with insurance verification and knowledge of prior authorization process. - Education: High School Graduate or above. - Specific Skills: Able to multi-task and handle stress well. Maintain a positive attitude and ability to be flexible. - Agrees with NAL mission statement.