Insurance Verification Specialist Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. At Hackensack Meridian Health at Home, we recognize our full- and part-time benefit eligible team members by offering a Total Rewards package including comprehensive Health Benefits, generous Paid Time Off, Travel Reimbursement as well as an investment in your future with a 401(k) match and Tuition Reimbursement. Per Diem team members are eligible to participate in Travel Reimbursement and may be eligible to receive a 401(k) match. At www.TeamHMH.com, you'll find the information, resources and tools that will help you to be successful at HMH. From great benefits and innovative wellness programs, to robust learning and development opportunities, we continue to cultivate an exceptional work environment where you can do the kind of work that leads to fulfillment and professional growth.
Responsibilities:
Responsible for all aspects of initial and ongoing insurance verification, including authorization and communication to insurance account representatives for claims submission, including corrections. Communicates with payers to include contract comparison, in network validation and negotiating single case agreements. Comprehensively completes these to assure claims are initiated correctly in the front-end billing arena. Works with internal clinicians to assure visits are authorized in a timely manner. Develops relationships with payers, answering community-based questions and entering the information timely to avoid financial sanctions. Role may be actively involved in telephonic intake and referral services for all referral sources requesting services at the Intake Department level. Receive requests from the field staff via EPIC for additional authorizations utilizing the EMR sidebar/insurance authorization work queues. Manage multiple work queues throughout the work day and update documentation in patients records to reflect obtained insurance authorization Request authorization from insurance companies. Inputs approved authorizations into EMR when received from insurance payer. Confirm the correct payor plan is attached to the patient's record. Communicate pertinent clinical information to the insurance company, utilizing clinician documentation provided in the patient's record. Investigate preferred providers when organization is out of network. Verify member eligibility and ensure organization is a preferred provider, Contact benefit provider to gather policy benefits/limitations and ensure services provided will be reimbursable. Ensure correct billing information and utilize contract`s for reference. Develop a good working relationship with insurance case managers. Document all communication into the EMR system. Enter complete information and authorization on all insurance cases. Communicate issues related to initial authorization and resolve them independently. Follow up to correct or obtain missing authorizations as appropriate. Maintain up-to-date account information of benefit plan coverage and contract services obligations. Maintain up-to-date insurance company documentation including key contacts and correct telephone numbers, faxes, etc. Utilizes system reports as needed Provide information to patients regarding programs and services available under their specific benefit plan. Identify issues and problems related to authorizations to ensure services are appropriately approved. Follow up on missing approvals and communicate problems immediately to case managers. Facilitate good communications between the Intake Department and Billing Department. Assist staff with all billing issues that arise from initial referral and/or ongoing referrals. Liaison with billing companies for all changes and modifications. Maintains knowledge of insurance authorization requirements specific to each payor, develops processes to adhere to requirements, and provides continuous education to clinicians, and intake team on those requirements Other duties and/or projects as assigned. Adheres to HMH's Organizational competencies and standards of behavior. Lifts a minimum of 10 lbs., pushes and pulls a minimum of 10 lbs., and stands a minimum of 2 hours a day
Qualifications: Education, Knowledge, Skills and Abilities Required:
- High School diploma, general equivalency diploma (GED), and/or GED equivalent programs
- One (1) to two (2) (years) of healthcare experience
- Two (2) to three (years) of insurance authorization experience
- Education, Knowledge, Skills and Abilities Preferred:
- Associates degree
- Licenses and Certifications Preferred:
- Licensed Practical Nurse
Compensation Minimum rate of $23.13 Hourly HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:
Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
Experience: Years of relevant work experience.
Education and Certifications:
Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
Skills:
Demonstrated proficiency in relevant skills and competencies.
Geographic Location: Cost of living and market rates for the specific location.
Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.
Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts. In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.
HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYERAll qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.
