The Federal OHI Specialist verifies other billable health insurance for both non-military and military retirees and dependents that utilize the base hospital which include base clinics, laboratory, radiology, and main/satellite pharmacy. The specialist provides assistance to customers and administrative staff and performs all duties as required to maintain contract compliance. The specialist is responsible for verifying patient insurance coverage and may be required to ensure procedures are covered by their insurance policy. The professional is responsible for entering data in an accurate manner and updating patient eligibility information in the various government approved billing systems and verify existing information is accurate. Also, providing services in a way that maximizes satisfaction and loyalty of those served and maintain confidentiality of patient information. This position requires a professional to spend extensive amounts of time on the phone with insurance companies.

Essential Duties and Responsibilities

· Insurance verification either telephonically or online for both in and outpatient.

· Extensive data entry and other various clerical tasks to expedite the insurance verification process.

· Ability to distinguish when procedures and/or medication require prior authorization.

· Coordinate with referral management and other departments to ensure insurance information is up to date.

· May be required to effectively make written and/or verbal inquiries to third party payers to verify insurance and/or determine if prior authorization is required.

· Will be required to extensively maintain insurance data for various military installations within all various government billing systems.

· Will be required to ensure any found insurance via government discovery system is accurately verified and entered timely.

· Maintain and distribute monthly reporting spreadsheets for various military installations.

· Will be required to work accurately in various government programs simultaneously (ABACUS, MHS-Genesis (Power Chart, Discern Reporting), Experian, and SSI).

· Provide information to patients regarding the Third-Party Collection Program.

· Comply with Federal DoD guidelines and state laws and policies, as well as company policies and procedures.

· Keep Regional Manager up to date on day-to-day events or any issues that may be affecting the site, workload etc.

· Perform other duties as required.

Education Requirements

· High School Diploma or equivalent

Skills and Abilities

· Maintain confidentiality of all information according to HIPPA guidelines.

· Must have a valid driver's license.