Insurance Verification Specialist

Mt. Washington Pediatric Hospital; Baltimore (MD); Presencial; USD 25.000 - 36.000; Jornada completa

Descripción de la vacante

Mt. Washington Pediatric Hospital in Baltimore, MD is seeking an on-site Insurance Verification Specialist to verify eligibility, benefits and coordinate approvals for outpatient services.

This role requires coordinating with families, insurance companies, and providers to ensure timely access to care, while communicating financial responsibilities clearly. The position emphasizes accurate data entry in EMR systems, knowledge of CPT/ICD-10 coding, and familiarity with Meditech.

Formación

• High School Diploma/Equivalent preferred.
• 3+ years of experience in the insurance or health care field required.
• Familiar with PC and essential office equipment including email, printer, scanner, copier, fax, and phone.
• Basic insurance and managed care structure knowledge required.
• General medical terminology, CPT and ICD-10 coding knowledge required.
• Familiar with hospital electronic medical records systems such as Meditech required.
• Effective verbal and written communication skills required.
• Ability to multi-task, prioritize and self-motivate daily.
• Ability to walk, sit, lift and stand for extended periods.

Responsabilidades

• Verify insurance eligibility, benefits, pre-certifications, prior authorizations and referrals for outpatient services.
• Verify and obtain required approvals from insurance companies, PCPs and families.
• Document appointment details accurately in EMR and registration systems.
• Notify families of financial responsibilities prior to appointments.
• Establish payment arrangements and direct families to Financial Assistance when needed.
• Work to meet department goals while handling multiple tasks.

Conocimientos

Insurance verification

Verbal communication

Multitasking

Medical terminology

Educación

High School Diploma/Equivalent

Herramientas

Meditech

MS Office

Descripción del empleo

INSURANCE VERIFICATION SPECIALIST

JOB SUMMARY

Authorization Specialists work on site at Mt. Washington Pediatric Hospital's Baltimore location to verify insurance eligibility, benefits and coordinate the approval of care for our outpatient families here at MWPH at our Rogers Avenue and Capital Region locations.

ESSENTIAL FUNCTIONS OF POSITION

• Confirming outpatient appointment schedules daily.
• Verifies insurance eligibility, benefits, pre-certifications, prior authorizations and referrals requirements for scheduled outpatient services via telephone and/or insurance websites.
• Obtains any required pre-certifications, prior authorizations and referrals from insurance companies, primary care physicians and families.
• Documenting all appointment details in the department's registration and electronic medical record keeping systems accurately including linking all referrals and authorizations to appointments accurately.
• Notifying families via phone or mail of any financial responsibilities prior to appointments including any non-covered services, deductibles, copays, and coinsurance amounts.
• Establishing payment arrangements and directing families to Financial Assistance programs when needed.
• Utilizing the ability to multitask, prioritize and self-motivate to achieve set team and department goals.
• Other duties as assigned.

POSITION REQUIREMENTS

• High School Diploma/ Equivalent preferred.
• 3+ years of experience in the insurance or health care field required.
• Familiar with the use of a personal computer and other essential office equipment including email software, printer, scanner, copier, fax machine and office telephone required.
• Basic insurance and manage care structure knowledge required.
• General medical terminology, CPT and ICD-10 coding knowledge required.
• Familiar with hospital electronic medical records systems such as Meditech required.
• Effective verbal and written communication skills required
• The ability to multi-task, prioritize and self-motivate daily.
• The ability to walk, sit, lift and stand for extended periods of time.

REPORTING RELATIONSHIPS

• Supervision Received Manager Outpatient Prior Authorization Department

INTERPERSONAL RELATIONSHIPS

• Regular direct contact with families, physicians, insurance representatives, case managers, social workers and other hospital clinical staff.

TOOLS/EQUIPMENT USED

• Personal computer, photocopier, fax machine, scanner, multi-line telephone

PHYSICAL ENVIRONMENT/WORKING CONDITIONS

• General office setting within a health care facility.
• Minimal risk of exposure to body fluids, infectious waste or blood-borne diseases. Pace of working environment is accelerated due to multiple demands, phone volume and time constraints.
• This position has limited telecommuting opportunity.

This job description identifies the general nature and level of work to be performed. It is not to be considered an exhaustive list of responsibilities, duties or skills required of an incumbent.

Revised 11/09/2023 Revised 12/18/19