Location: Cedar Rapids,IA, USA
Overview
The Lead Insurance Specialist is responsible for complex insurance eligibility and benefits verification as well as complex denial work queues within Therapy Plus, Witwer Children's Therapy, Hospital Outpatient Therapy, PMR physician clinic and other PMR department(s) as needed. Also oversees and assists the PMR physician clinic with insurance benefit verification and pre-authorizations for procedures. The Lead Insurance Specialist is a resource for the business operations manager, business supervisor, lead scheduling/billing specialist(s), therapy managers, scheduling/billing specialists, therapists and other PMR providers regarding all aspects of patient insurance. This position also leads a team of insurance specialists responsible for all insurance work across the division. Responsibilities include ensuring adequate staffing, training, and maintaining competencies for insurance staff. Also, adhering to detail in the performance of procedures, solving practical problems, resolving conflict, and implementing constructive change. Supports the direction and accomplishment of hospital short and long range goals.
Why UnityPoint Health?
* Culture - At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
* Benefits - Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you're in.
* Diversity, Equity and Inclusion Commitment - We're committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
* Development - We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
* Community Involvement - Be an essential part of our core purpose-to improve the health of the people and communities we serve.
Hear more from our team members about why UnityPoint Health is a great place to work at .
Responsibilities
Billing/insurance
* Verifies complex patient insurance eligibility and coverage via phone or internet. Documents in account notes in EPIC.
* Resource/assist in the PMR division for complex pre-authorizations, including therapy, Botox, prescriptions, and Neuropsych testing. Obtain all necessary pre-authorizations for PMR Clinic procedures.
* Researches and maintains database of changes to Medicare (CCI edits and local payer coding), Medicaid, commercial and worker's compensation insurance billing regulations for all departments and CPT codes billed.
Accurate billing/collections/denials
* Responds to patients' questions regarding their account and assists in finding solutions to billing concerns.
* Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.
* Problem solves, analyzes and collaborates with patient, therapist, physician providers, case managers, Central Billing Office, Revenue Cycle department, and insurance companies to identify and resolve billing and denial issues, including sending appeals and trouble-shooting and correcting claim or account errors.
* Identifies denial and billing processes that need improvement to maximize efficiency and ensure proper payment within the division.
* Reconciles daily patient attendance and charges posted with revenue/usage reports and chart audits for PMR Clinic.
* Performs additional chart and charge audits as needed.
* Establishes and maintains accurate files using word processing and spreadsheet documents.
* Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information related to billing/insurance/denials.
Leadership, Training and Coverage
* Responsible for maintaining adequate coverage of insurance work in all PMR departments on a day to day basis.
* Trains insurance staff to assist in all appropriate duties.
* Keeps current with changes in hospital procedures and trains staff on the new procedures.
* Provides leadership, training, and guidance to insurance staff.
Qualifications
* Associate's degree required, or an equivalent combination of education and experience
* Extensive knowledge of Medicare (CCI edits and local payer coding), Medicaid, commercial and worker's compensation insurance billing regulations
* Minimum 1 year prior secretarial experience in a medical environment preferred
* Writes, reads, comprehends and speaks fluent English
* Multicultural sensitivity
* Proficient in Microsoft Office and Outlook
* Customer/patient focused
* Critical thinking skills using independent judgment in making decisions
* High organizational skills
* Ability to multi-task
* High attention to detail
* Experience with medical insurance processing
* Medical terminology and ICD-10 coding
* Ability to articulate insurance information as it relates to patient understanding and any action needed
* Use of usual and customary equipment used to perform essential functions of the position.
* Area of Interest: Patient Services;
* FTE/Hours per pay period: 1.0;
* Department: Rehab Administration;
* Shift: Full time, first shift;
* Job ID: 156873;