Insurance Claims Specialist (Spine)

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POSITION SUMMARY : Greets and receives the patient into the health care system. Manages the registration process to ensure the financial viability of WVUH-E. Responsible for accurate and timely interviewing of patients and/or relative in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process. Communicates with physician offices concerning clinical information. Communicates and supports hospital departments using scheduling system. Schedule multiple services in correct clinical sequence. Ensures that all state/federal regulations are met. Initiates and coordinates the information necessary for prompt and efficient admission, transfer or discharge of patients in compliance with state and federal regulations. Maintains knowledge of revenue cycle operations, third party reimbursement, and medical terminology. Uses excellent customer service, written and oral communication skills.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent required.

EXPERIENCE:

1.Experience and knowledge in admissions, registration, and insurance verification. Excellent oral and written communication skills.

PREFERRED QUALIFICATIONS :

EXPERIENCE:

1.College course work in accounting or business-related fields preferred.

2.Three to five years of recent experience in a physician/hospital scheduling and registration or business office environment required.

3.Use a computer keyboard, monitor and mouse. Answer telephones and transcribe messages. Communicate verbally, written and electronically with healthcare personnel, families and patients.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.

Obtains demographic/billing/insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing.

Properly performs patient registration according to procedure especially regarding orders/insurance verification information/pre cert/authorizations.

Performs insurance verification functions in a positive and helpful manner. Maintains multiple insurance forms from Medicaid, Federal Compensation, and other various companies. Accurately completes primary, secondary, workers compensation and Medicare forms. Assists that front office is manned effectively at all times. Follows up on accounts as directed.

Performs reception functions in a positive and helpful manner.

Utilizes BrickStreet's Web site directly for WV workers compensation authorizations.

Maintains patient confidentiality and adheres strictly to the departmental code of ethics.

Maintains work environment in a clean and orderly fashion performing housekeeping duties as necessary.

Attends all in-services and staff meetings as assigned and required.

Shows initiative in daily work on a consistent basis and serves as a role model for other employees.

Understanding of applicable computer systems, i.e., Scheduling, Medical Necessity and Insurance Verification.

Coordinates and assists in the completion of all activities relating to the patient's finances, to facilitate the collection and distribution of information and to expedite a smooth and timely billing and collection process.

Verifies insurance. Validate pre-cert/pre-auth information after completion of insurance verification and record results in system. Performs other insurance related functions as required or necessary.

Understands and uses applicable CPT And ICD-9 codes.

Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verifies medical necessity for applicable payer and service.

Follows hospital, state and federal guidelines for ensuring safe environment for workers, patients and public. Ensures compliance by staff to hospital, governmental and insurance regulations.

Communicates and interacts with clients, families, visitors, physicians, departmental and hospital staff and the public in general in a manner that demonstrates professionalism and concern for the individuals' need(s).

Remains current and responsive to changes in healthcare delivery, standards established by professional organizations, regulatory and accrediting bodies and the needs of the organization.

Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative levels.

Willingly accepts assignments within scope of practice, skill set and level of competence.

PHYSICAL REQUIREMENTS: 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Must meet Department of Labor's MEDIUM duty standard (MEDIUM WORK- exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly)

2.Able to bend, stoop, reach and be capable of normal rotation, standing and walking for an 8-10-hour shift.

3.Able to lift 40 pounds from floor to waist. Able to ambulate, position, turn and pull up self-assisting adult patients.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Able to wear latex or vinyl gloves, with frequent changes and hand washing. Able to tolerate working with and around noxious odors.

2 . May be scheduled to work various shifts based on departmental and patient needs. May be required to travel between facilities/buildings.

3.May be exposed to virus, disease, and infection from patients and specimens in working environment. May be exposed to traumatic situations including psychiatric crisis, physical injuries and death.

SKILLS AND ABILITIES:

1.Working knowledge of office equipment and computers.

2.General knowledge of hospital payment plan guidelines. Working knowledge of healthcare insurance payers. Basic knowledge of medical terminology.General knowledge of hospital clinical departments and services protocols. Strong negotiation skills.

3.Strong communication skills. General knowledge of time of service collection procedures preferred. Excellent customer service and telephone etiquette. Must demonstrate the ability to use tact and diplomacy in dealing with others.

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

UNTWN Uniontown Hospital

Cost Center:

68 UNTWN Orthopaedics

Address:

500 W Berkeley Street Uniontown Pennsylvania