Insurance Verification Specialist

BIDMC(Beth Israel Deaconess Medical Center) Boston, MA 2019-04-12

Department Description: Financial Clearance Department (Revenue Cycle Operations). The position is located at 113 Tremont St.

Job Location: Boston, MA

Req ID: 29345BR

Job Summary: Reporting to the Financial Clearance Unit Manager, this position utilizes state of the art online eligibility verification tools to confirm and update the patient record timely and accurately.

Following established procedures the Eligibility Verification Specialist ensures the most accurate insurance and demographic information is verified, and up to date in BIDMC's system for billing to third parties in advance of the patient's visit or admission.

Essential Responsibilities:
  1. Using web based applications and working daily reports for upcoming visits, procedures, admissions etc., this position confirms eligibility and coverage as well as plan type, PCC, PCP, and coverage effective dates utilizing on-line tools to update patients' in the registration system.
  2. The Specialist rechecks and confirms insurance eligibility at regular intervals prior to appointments/admissions to ensure that any changes in coverage are corrected before the patient is seen.
  3. Utilizing in-house and external online software, the Specialist researches, finds, and verifies insurance coverage for patients who are initially listed as Self Pay. The Specialist then updates the insurance record to properly bill the identified insurance instead of the patient.
  4. When required conducts outbound calls to patients to resolve registration/insurance discrepancies and enters new or updated demographic and fiscal information into the medical center's registration/billing systems to support proper billing.
  5. Communicates clearly, concisely and effectively and contributes to a positive patient experience for patients and families. Demonstrates positive, proactive approach required for the implementation of new programs and services which support department's goals and objectives.
Required Qualifications:
  1. High School diploma or GED required. Associate's degree preferred.
  2. 0-1 years related work experience required.
  3. Proficient key boarding skills for data entry.
  4. Ability to navigate between more than one computer systems.
  5. Demonstrate collaborative and respectful behavior and partner with all team members to achieve goals.
  6. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
  1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
  2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
  3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
  8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally