Insurance Specialist

UNC Health Care; Rocky Mount (NC); Hybrid; USD 42,000 - 62,000; Full time

Job summary

UNC Health Nash is seeking a detail‑oriented insurance verification specialist to ensure accurate benefits verification and pre‑certification for procedures. You will interact with patients, coordinate with providers, and support admissions and day surgeries within a hybrid work setting.

The role emphasizes accurate data entry, understanding of CPT/ICD-9 and revenue cycle processes, and collaboration with the financial department to address uninsured or underinsured cases.

Qualifications

• High School Diploma or GED required; formal business education with emphasis on insurance, CPT coding and ICD-9 applications.
• 1–3 years experience in Healthcare/Medical admissions or related area preferred.
• Experience with insurance verification, pre-certification/authorization processes, and billing procedures preferred.

Responsibilities

• Verify insurance eligibility via designated software and log into billing system.
• Obtain authorizations from insurance companies and enter data into system.
• Provide patient-facing customer service with compassionate, accurate information.
• Participate in quality improvement activities and data collection for CQI programs.
• Assist with miscellaneous duties to support admissions and registration operations.

Skills

Medical terminology

Revenue cycle knowledge

Keyboard proficiency

System navigation

Education

High school diploma or GED

Insurance/CPT/ICD-9 coursework

Tools

Eclipsys Financial System

EPIC Clinical System

Emdeon

Proficient Health Order Control System

Allscripts AM/PFM

Job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

UNC Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve a diverse patient base, spanning Nash, Edgecombe, Halifax, Wilson Counties, and beyond. With a steadfast commitment to elevating community health through exceptional care, we prioritize excellence, compassion, and innovation, ensuring every individual receives the highest standard of support. Joining our team means becoming an integral part of our dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this transformative journey, where your contributions will make a lasting impact on our community's health and wellbeing.

Summary

Responsible for the timely verification of medical insurance benefits: calling private insurance companies, Medicare, and Medicaid to obtain benefit information, determining insurance compatibility with health-care provider programs, coordinating with patients regarding their insurance benefits and medical providers programs, re-verifying existing patient insurance coverage, and determining if an insurance benefit plan considers selected products appropriate based on patient need. Representative will obtain pre-certification or authorization for procedures, verify insurance for both admissions and pre-admissions, specified procedures and day surgeries, and alert the financial department about uninsured or underinsured patients.

Responsibilities

1. Insurance Verification Utilize designated software to validate the insurance eligibility on all designated accounts. Accurately enters information into the billing database.

2. Authorizations Provides initial contact to insurance authorization companies to obtain approval information and accurately enters the information into the billing system.

3. Customer Service Employee understands and demonstrates the importance of satisfying the needs of patients/customers by interacting with him/her in a friendly and caring manner being attentive to the customer's needs both psychologically and physically and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience throughout the encounter.

4. Participates in quality improvement activities. Performs data collection and idea generation pertinent to quality improvement programs, as assigned. Demonstrates a basic knowledge of the fundamentals of performance improvement.

5. Performs miscellaneous duties, as needed, to support operations and the provision of services. Answers telephone calls to the area promptly, and courteously addresses caller's needs. Stays knowledgeable of the Admission Officer’s role in the event of local disaster, and demonstrates when requested, the ability to admit patients in accordance with the disaster plan. Effectively explains procedures and protocols, demonstrates procedures and techniques, and answers questions when assisting with the orientation of new employees. Accomplishes routine and non-routine miscellaneous assignments in accordance with procedure, or instructions, and time frames.

6. Acquires age-specific knowledge necessary to provide appropriate service and communications. Appropriately uses age-specific concepts when communicating with employees, patients, visitors and others.

7. Takes an active role in self development. Participates in self evaluation by making notes/comments in the Accountability section of the annual review, updating skills checklist, and mutually setting professional goals for achievement with the manager. Always reads and signs new policies, procedures, CQI materials and memos. Attends scheduled meetings, when possible, and reads/signs minutes all of the time. Attends all mandatory education unless absence has prior approval by manager. Participates in continuing education/in-service/skills labs to maintain competencies. Accepts opportunities to cross‑train in other areas of the department, and adequately performs the basic functions of other departmental staff in accordance with the standards for the position, when necessary. Participates in, and assures that, documentation of own continuing education and self development activities is current and valid by signing rosters and submitting copies of CE certificates for transcript.

Other information

Education Requirements

• High School Diploma or GED
• Formal business education course work with emphasis on insurance, CPT coding and ICD-9 applications.

Licensure/Certification Requirements:

• None

Professional Experience Requirements:

• 1-3 years experience in Healthcare/Medical - Admissions or related experience
• 1 year experience in Healthcare/Medical - Acute Care setting
• 1-3 years experience performing insurance verification or 1 year experience working with medical billing procedures or medical insurance programs preferred.

Additional Specialized Knowledge and Skills:

• Proficient in the use of keyboard and basic computer application skills.
• Must demonstrate proficiency in the use of Eclipsys Financial System, EPIC Clinical System, Emdeon address and insurance verification system, and Proficient Health Order Control System.
• Medical Terminology - Familiar with ICD9 and CPT codes.
• Experience with Allscript's AM/PFM, EPIC, Proficient, Siemen's imaging a plus.
• Comprehension of revenue cycle activities

Job Details

Legal Employer: Nash Hospitals

Entity: Nash UNC Health Care

Organization Unit: NGH Registration Discharge

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: NASH HC

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.