Insurance Verification Specialist

Baystate Noble Hospital; Springfield (MA); On-site; USD 27,000 - 36,000; Full time

Job summary

Baystate Health is seeking an Insurance Verification Representative in Springfield, MA, to review, verify, and secure patient demographic and insurance information, obtain authorizations, and initiate required certifications for sponsored admissions.

The role involves minimizing bad debt, maximizing reimbursement, and collaborating across Care Management, Financial Counselors, and Patient Accounting to resolve denials and ensure accurate documentation.

Qualifications

• Medical billing and/or Authorization and Referral focus.
• Healthcare Accounts Receivable experience is preferred.

Responsibilities

• Verify eligibility and obtain authorizations/referrals for payers.
• Identify coverage gaps and coordinate with providers and departments to minimize self-pay balances.
• Follow up with payers to resolve coverage issues and document activity.
• Collaborate with Case Management, Denials Management, and Patient Accounting to recover payment for denials.
• Maintain knowledge of payer guidelines and use web portals and carrier communications.
• Resolve insurance authorization and assignment issues independently.
• Participate in cross training to provide efficient, customer-friendly service.
• Meet productivity standards and maintain high account accuracy (≥97%).
• Demonstrate proficient use of necessary computer programs.

Skills

Microsoft Office Suite Skills

Job description

Summary:

Under the direction of the Insurance Verification Supervisor and Manager an Insurance Verification Representative will review, verify, and secure patient demographic and insurance information, obtain authorization information, initiate required certifications for sponsored admissions, and work related denials in order to minimize bad debt expenses and maximize reimbursement.

Job Responsibilities:

1. 1) Secures accounts in order to obtain proper reimbursement. Verifies eligibility and obtains benefits for assigned accounts, completes Notifications of Admissions and births, change of admission status and obtains authorizations/referrals with knowledge of 3rd party requirements for claims submissions for assigned payers.
2. 2) Obtains certification / authorization when required and identifies potential gaps in coverage (deductibles, uncovered days, etc) and collaborates with referring provider, PBO, Patient Accounting, Managed Care, Case Management, Financial Counselors, patient employer, etc. to minimize self pay balances.
3. 3) Follows up with payers to resolve coverage/benefit issues. Accurately and completely documents account activity in necessary applications.
4. 4) Collaborates with Case Management, Denials Management, and Patient Accounting to recover payment for assigned denials.
5. 5) Maintains knowledge of ever-changing payer guidelines pertaining to benefit, eligibility, and authorization information by use of web portals and carrier communications.
6. 6) Independently resolves insurance authorization and assignment issues.
7. 7) Participates in cross training to promote efficient and customer friendly service to meet or exceed established quality and productivity standards.
8. 8) Meets all productivity standards for the position.
9. 9) Maintain an account accuracy average rate of >/= 97%.
10. 10) Demonstrates understanding and skilled use of necessary computer programs.

Required Work Experience:

1. 1) Medical billing and/or Authorization and Referral focus

Preferred Work Experience:

1. 1) Healthcare Accounts Receivable or equivalent

Skills and Competencies:

1. 1) Microsoft Office Suite Skills

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$19.29 - $22.16 - $25.87

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.