GENERAL SUMMARY:

Under general supervision, the Insurance Specialist identifies and determines in accordance with established policies and procedures:

The accuracy and completeness of financial, insurance and/or demographic information for patients receiving care HFHS. Accountable and responsible for all pre-admissions, admissions, and specified scheduled outpatient services rendered at HFHS. Investigates and reviews the accuracy and completeness of insurance information upon pre-admission and/or admission to ensure account is secure prior to discharge. Obtains benefit, co-pay, deductible, and co-insurance information. Verifies insurance eligibility and benefit information and confirms that all insurance requirements are met, including but not limited to referrals and authorizations. Resolves problem accounts to determine primary insurance and/or COB information.

EDUCATION REQUIRED:

High school diploma or GED equivalent is required.

EXPERIENCE REQUIRED:

Two (2) years of experience related to healthcare insurance eligibility, insurance verification or insurance billing in a hospital/medical office setting. Knowledge of various insurance coverage, COB rules of priority and processing procedures. Insurance payor systems experience required. EPIC training/experience preferred. ICD-10 medical terminology experience preferred. Ability to adjust to new technologies as introduced. Strong computer skills and working knowledge of Microsoft Office products. Ability to perform a variety of tasks in a fast-paced environment with frequent interruptions. Additional Information Organization: Community Care Services Department: HHC Billing Shift: Day Job Union Code: Not Applicable