Insurance Specialist-Home Care-Wall Twp.-Full Time-Benefits
How have you impacted someone’s life today?
At Hackensack Meridian Health, our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of nursing services will allow you to apply your skills in multiple settings while building your career all within New Jersey’s premier healthcare system.
At Hackensack Meridian Health at Home, we recognize our clinicians by offering a Total Rewards package including:
Comprehensive Health Benefits, generous Paid Time Off, Travel Reimbursement as well as an investment in your future with a 401k match and Tuition Reimbursement.
For further rewards offered, please visit www.TEAMHMH.COM
Responsible for all aspects of initial and ongoing insurance verification, including authorization and communication to insurance account representatives for claims submission, including corrections. Communicates with payers to include contract comparison, in network validation and negotiating single case agreements. Comprehensively completes these to assure claims are initiated correctly in the front-end billing arena. Works with internal clinicians to assure visits are authorized in a timely manner. Develops relationships with payers, answering community-based questions and entering the information timely to avoid financial sanctions. Role may be actively involved in telephonic intake and referral services for all referral sources requesting services at the Intake Department level.
- Receive requests from the field staff via EPIC for additional authorizations utilizing the EMR sidebar/insurance authorization work queues. Manage multiple work queues throughout the work day and update documentation in patients records to reflect obtained insurance authorization
- Request authorization from insurance companies. Inputs approved authorizations into EMR when received from insurance payer.
- Confirm the correct payor plan is attached to the patient's record
- Communicate pertinent clinical information to the insurance company, utilizing clinician documentation provided in the patient's record.
- Investigate preferred providers when organization is out of network.
- Verify member eligibility and ensure organization is a preferred provider, Contact benefit provider to gather policy benefits/limitations and ensure services provided will be reimbursable. Ensure correct billing information and utilize contract¿s for reference.
- Develop a good working relationship with insurance case managers. Document all communication into the EMR system.
- Enter complete information and authorization on all insurance cases. Communicate issues related to initial authorization and resolve them independently. Follow up to correct or obtain missing authorizations as appropriate.
- Maintain up-to-date account information of benefit plan coverage and contract services obligations.
- Maintain up-to-date insurance company documentation including key contacts and correct telephone numbers, faxes, etc.
- Utilizes system reports as needed
- Provide information to patients regarding programs and services available under their specific benefit plan.
- Identify issues and problems related to authorizations to ensure services are appropriately approved.
- Follow up on missing approvals and communicate problems immediately to case managers.
- Facilitate good communications between the Intake Department and Billing Department.
- Assist staff with all billing issues that arise from initial referral and/or ongoing referrals.
- Liaison with billing companies for all changes and modifications.
- Maintains knowledge of insurance authorization requirements specific to each payor, develops processes to adhere to requirements, and provides continuous education to clinicians, and intake team on those requirements
- Other duties and/or projects as assigned.
- Adheres to HMH's Organizational competencies and standards of behavior.
- Lifts a minimum of 10 lbs., pushes and pulls a minimum of 10 lbs, and stands a minimum of 2 hours a day
Education, Knowledge, Skills and Abilities Required:
- High school diploma
- One (1) or More Years Healthcare Experience
- Two (2) or More Years of Insurance Authorization Experience
Education, Knowledge, Skills and Abilities Preferred:
- Associates degree
Licenses and Certifications Preferred:
- Licensed Practical Nurse
Hackensack Meridian Health (HMH) is a Mandatory COVID-19 and Influenza Vaccination Facility
As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.