Insurance Verification Specialist - Patient Access in Mountain Home, Arkansas at Baxter Health

SUMMARY: Under the direction of the Patient Access/Central Scheduling Manager, the Insurance Verification Specialist is responsible and accountable for the daily oversight of all Prior authorization/Insurance and Eligibility verification for Surgery procedures as scheduled and/or add on procedures for both Hospital and OPSC and for other procedural departments of the hospital. Responsible for contacting provider(s) offices regarding the necessity of prior authorizations to ensure appropriate reimbursement. Responsible for contacting the appropriate provider(s) as necessary when Insurance and Eligibility changes in coverage are identified. Utilizes a variety of communication methods to effectively communicate inter-departmentally, with provider(s) offices as well as with Insurance companies. Responsible for the identification of any tests/procedures completed that may require retro-authorization in order to obtain reimbursement. Works with multiple hospital departments in the creation of financial accounts as necessary prior to the treatment of the patient. Works continually with schedulers and physician offices to ensure all authorizations required are in place prior to the scheduling of the test/procedure. Functions as subject matter expert to both internal and external customers.

BAXTER HEALTH COMPLIANCE RESPONSIBILITIES

Understands and adheres to Baxter Health standards as they appear in Healthstream Policy Manager.

Required to work with regularly to carryout, initiate and/or implement best practices for the Baxter Health.

JOB REQUIREMENTS

Education: High School Diploma or equivalent.

Experience: 12 to 18 months related experience and/or training in the healthcare and/or office/clerical and customer service fields.

Other: Preferred applicant will have a working knowledge of medical terminology, ICD 10, CPT and HCPCS coding

basics. Adaptability to multiple systems is essential-depth knowledge of federal and state employment laws. Working knowledge of Microsoft Office Suite, databases and general office equipment. Must be extremely detail oriented, organized and conscientious to ensure high quality work. Excellent time-management and follow-up skills to ensure work deadlines are met. Outstanding communication, presentation and interpersonal skills. Must be a positively contributing team player and possess willingness to be cross-trained in other functional areas. Ability to maintain a high degree of confidentiality with regard to employment data, HIPAA, and departmental operations.

Preferred: Associate Degree in Business Administration or related field preferred and/or equivalent relevant work experience.

Primary Source Verification:

Original Transcripts

Safety Sensitive Designation:

No

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without an accommodation. While performing the duties of this job, the employee is required to perform the following: Must have the ability to communicate effectively, orally and in writing, to solve problems and make decisions. Spend 8 hours or more in front of computer, monitor or similar screen utilizing keyboard and/or mouse, daily. Ability to stand and walk, bend, stoop and twist, and occasionally lift 10 lbs. Acuity to the five senses is required. Must be able to handle critical and highly stressful situations with efficiency and composure.

Work Environment
Office setting, supporting a healthcare environment.

Position Type and Expected Hours of Work

This is a position supports a healthcare setting which is open 24 hours a day, 365 days a year. Monday – Friday, 8+ hour shifts.