Insurance Specialist - Detroit full time

📁
Business (Non-Clinical)
📅
212011 Requisition #

This position will be located at the Detroit HAP building. Hours are Monday-Friday 8am-4:30pm.  Remote work may be available after 6 months of successful training and proof of knowledge. 

 

GENERAL SUMMARY: 

Under general supervision, identifies and determines in accordance with established policies and procedures the accuracy and completeness of financial, insurance and/or demographic information for patients receiving care HFHS. Accountable and responsible for all pre-admissions, admissions, and specified scheduled outpatient services rendered at HFHS. Investigates and reviews the accuracy and completeness of insurance information upon pre-admission and/or admission to ensure account is secure prior to discharge. Obtains benefit, co-pay, deductible, and co-insurance information. Verifies insurance eligibility and benefit information and confirms that all insurance requirements are met, including but not limited to referrals and authorizations. Resolves problem accounts to determine primary insurance and/or COB information. 

 

PRINCIPLE DUTIES AND RESPONSIBILITIES: 

A variety of functions and responsibilities related to insurance verification and identifying authorization requirements prior to and/or after discharge of patient, which includes: 

  • Research and review all insurance plans and confirms patient benefit eligibility, including patient liabilities, clauses, riders, and secondary payor information (coordination of benefits) via internal and external resources including contacting payor representatives as needed. 
  • Reviews and interprets insurance group pre-certification requirements. Ensures proper pre-authorizations have been obtained. Executes on-line operations for specific payors to complete the pre-certification process. Communicates data to HFHS Utilization Management Department for further medical review. 
  • Resolves discrepancies with the patient and/or family members, employers and insurance companies to assist in obtaining insurance information. Interviews patients and/or family members; advises patient with regards to next steps or processes for securing financial coverage. Reviews and analyzes third party COB screen prior to billing to prevent claims rejection. Works with patient or family member regarding outstanding COB issues. 
  • Reviews, analyzes and corrects COB discrepancies and other related issues to ensure the integrity of the insurance information is accurate prior to discharge. 
  • Handles insurance questions and/or obtains information from various HFHS areas including but not limited to clinics, physicians, patients, attorneys, employers and outside agencies via telephone or mail. 
  • Prepare and ensures account for accuracy in preparation for billing to third party payors utilizing several different arenas within HFHS computer system as well as other on line systems. 
  • Obtains referral from referring physician office, prior to admission, as required by the payor.
  • Maintains status of all accounts pending verification reviews, utilizing applicable work queues, and takes appropriate action to resolve accounts. 
  • Represents HFHS to external agencies on issues involving workers compensation, motor vehicle accidents and/or third party liability admissions and issues pertaining to financial policies and procedures. 
  • Performs functions necessary to secure referrals/authorizations on applicable encounters, maintaining an appropriate lead-time as established by departmental guidelines. 
  • Responsible for referring accounts to the HFHS funding source vendor when an insurance cannot otherwise be secured. 

 

Provides World Class Service Excellence to patients: 

  • Warm patient greeting and closing. (AIDET) 
  • Service Recovery (HEART) 
  • Adheres to Chief First Impressions Officer (CFIO) standards.
  • Maintains Front Desk and Lobby Appearances according to policy.

EDUCATION/EXPERIENCE REQUIRED: 

  • High school diploma or GED equivalent is required. 
  • Two (2) years of experience related to healthcare insurance eligibility, insurance verification or insurance billing in a hospital/medical office setting. 
  • Knowledge of various insurance coverage, COB rules of priority and processing procedures. 
  • Insurance payor systems experience required. 
  • EPIC training/experience preferred. 
  • ICD-10 medical terminology experience preferred. 
  • Ability to adjust to new technologies as introduced. 
  • Strong computer skills and working knowledge of Microsoft Office products. 
  • Ability to perform a variety of tasks in a fast-paced environment with frequent

    Overview

       Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

       $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

       including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

       other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

       now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

       of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

       health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s  

       major academic medical centers, receiving between $90-$100 million in annual research funding and

       remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

       education and training, the health system has trained nearly 40% of physicians currently practicing

       in the state and also provides education and training for other health professionals including nurses,

       pharmacists, radiology and respiratory technicians. visit HenryFord.com.

     Benefits

       Whether it's offering a new medical option, helping you make healthier lifestyle choices or

       making the employee enrollment selection experience easier, it's all about choice.  Henry

       Ford Health System has a new approach for its employee benefits program - My Choice

       Rewards.  My Choice Rewards is a program as diverse as the people it serves.  There are

       dozens of options for all of our employees including compensation, benefits, work/life balance

       and learning - options that enhance your career and add value to your personal life.  As an

       employee you are provided access to Retirement Programs, an Employee Assistance Program

       (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness,                 and a whole host of other benefits and services.  Employee's classified as contingent status are not         eligible for benefits.    

      Equal Employment Opportunity/Affirmative Action Employer

        Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

        committed to the hiring, advancement and fair treatment of all individuals without regard to

        race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

        weight, marital status, family status, gender identity, sexual orientation, and genetic information,

        or any other protected status in accordance with applicable federal and state laws.

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