Insurance Eligibility & Authorization Specialist

Sioux Center Health; Pierre (SD); On-site; USD 2,686,000 - 3,513,000; Full time

Benefits offered by this job

PTO available day 1 for eligible hires

Up to 5% employer matching retirement

Career development and mentorship

Job summary

Avera St Mary's Hospital in Pierre, SD, is looking for an Insurance Eligibility and Authorization Specialist to verify coverage, secure authorizations, and estimate patient financial responsibility to prevent denials and optimize reimbursement.

You will work with multiple departments to ensure accurate information, maintain compliance with HIPAA/EMTALA, and communicate payment expectations to patients and families as part of a compassionate care team.

Qualifications

• Required: 1-3 years related experience in billing, insurance or registration.
• Required: 1-3 years healthcare experience.
• Preferred: Associate's finance, business or healthcare.

Responsibilities

• Process eligibility and secure full benefit coverage information with insurance companies and employers, confirm demographic information is correct, and ensure coordination of benefit and plan codes are accurate.
• Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials.
• Obtain necessary referrals, authorizations and pre-certifications from physicians and payers and enter information into the health information system.
• Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters information.
• Calculate and communicate patient estimates for hospital services using a deposit matrix to determine estimated patient responsibility.
• Educate patients on benefits, offer payment options, identify needs for financial assistance and provide charity applications.
• Screen self-pay patients for potential payer coverage and direct accounts to advocacy team for review.
• Provide communication concerning changes in insurance coverage prior to billing.
• Maintain professional development and compliance with regulations (CMS, HIPAA, EMTALA) as they pertain to insurance processes.

Education

Associate's finance, business or healthcare.

Job description

Avera St Mary's Hospital in Pierre, SD, is looking for an Insurance Eligibility and Authorization Specialist to verify coverage, secure authorizations, and estimate patient financial responsibility to prevent denials and optimize reimbursement.

You will work with multiple departments to ensure accurate information, maintain compliance with HIPAA/EMTALA, and communicate payment expectations to patients and families as part of a compassionate care team.