The Insurance Verification Specialist 1, under general supervision, provides patients, physicians and internal hospital personnel with insurance benefit information. This position ensures timely verification of insurance benefits and financial clearance which has a direct impact to the organization's reimbursement from payers for patient accounts that are scheduled and unscheduled.
ESSENTIAL FUNCTIONS OF THE ROLE
Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.
Completes appropriate payor forms related to notification and authorization.
Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
Calculates accurate patient financial responsibility.
Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patient's account prior to scheduled or unscheduled service during the patient's hosptial stay.
Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.
KEY SUCCESS FACTORS
1 year of healthcare or customer service experience preferred.
Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
Ability to know and adhere to payer guidelines by plan and service type.
Requires good listening and communication skills, and professional telephone etiquette.
Ability to maintain a professional demeanor in a highly stressful and emotional environment, behavioral health and/or suffering patients in addition to life or death situations.
Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.
Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
Excellent data entry, numeric, typing and computer navigational skills.
Basic computer skills and Microsoft Office.
Our competitive benefits package includes the following
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!