Insurance Specialist

DeKalb Medical - Decatur, GA3.7

30+ days agoFull-time

Five-Star Rated:
Recipient for Treatment of Heart Attack in 2013

Recipient for Treatment of Chronic Obstructive Pulmonary Disease in 2013

Award Winning Care:
Outstanding Achievement Award for Cancer Care (2007-2013)
Surgical Weight Loss Center of Excellence (2007-2013)
Sleep Disorders Center of Excellence
2010 Corporation of the Year- DeKalb Chamber of Commerce

Top Workplace in Healthcare:
Recognized by our Employees and The Atlanta Journal-Constitution as a 2011 Top Workplace
Voted by our Employees and Atlanta Magazine as a 2008 Best Place to Work

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Insurance Specialist must have a thorough understanding of the pre-certification and insurance verification process. Insurance Specialist will work closely with Case Management, Financial Counselors, and members of the Revenue Cycle Division. Insurance Specialist will also collaborate with nursing units, emergency department staff, physicians and their staff and insurance companies. Insurance Specialist will be responsible for insurance verification on a variety of patient types, which may include outpatient, inpatient or observation admissions.

1. Must follow up with Commercial and Manage Care providers, worker's compensation claims and all other payors including Medicaid and Medicare in a timely manner to ensure authorization or insurance verification.
2. Responsible for working denials through ISuites relating to Coordination of Benefits coverage, eligibility and pre-certification.
3. Reviews and responds to the #QA Patient Access email box and documents necessary corrections in Invision.
4. Utilize various online payor websites or portals, VoiCert, ORSOS and print daily census for inpatients.

Reports to: Manager, Financial Assessment Services Team and/or Manager, Access Center

Extend of Supervision Received: Varies

  • High School Education, Bachelor's preferred.
  • Knowledge of Third Party payers, billing requirements, and reimbursement methods.
  • Knowledge of medical terminology.
  • Excellent communication skills.
  • Professional appearance.
  • Good PC software skills.
  • Must work independently and maintain workflow.
  • Knowledge of multi-registration and front-end processing.
  • Service excellence.
  • Handle incoming calls professionally and timely.
  • Demonstrate service and commitment in working with peers, management team and other hospital stall.