Insurance Specialist

Job Details: Job Location: Hospital Main Campus

• Idaho Falls, ID, Position Type: Full Time, Education Level: High School, Salary Range: Undisclosed, Job Category: Health Care, Mountain View Hospital is looking for a Insurance Specialist to join our team!

JOB SUMMARY

Arrange for the efficient and orderly admission, scheduling, rescheduling and discharge of physical therapy patients. Ensure that the patient’s information is collected, entered into hospital computer system accurately, and that all patients are aware of hospital policies and procedures. Checks appointments to make sure the diagnosis will support medical necessity as per insurance company and verify that all visits that need preauthorization are done prior to the patients first visit with a therapist.

Works closely with referring offices to be used as a resource in helping them get necessary paperwork to start pre-authorizations, prove medical necessity, or to perform a retro-authorization. Verify, track and help oversee Worker’s Compensation and Medicare cases and visits to avoid exceeding approved benefits.

BENEFITS

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages.

Benefits

Medical, Dental and Vision Insurance Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off Retirement Plans (401K with up to 6% match) Earned Quarterly Bonus Program Education Reimbursement Program Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES

1. Responsible for registration of new physical therapy patients, obtaining and entering demographics, insurance information, and emergency contact; or verification of the same if the patient has previously received physical therapy services at MVH. Must maintain approved accuracy level on admission process.
2. Communicates appropriately and clearly to the patients, supervisor, nurse managers, coworkers and physicians.
3. Collects co-pays, cost-shares and deductibles due as required. Posts and makes a daily report of cash receipts.
4. Maintains department records, reports, forms and files.
5. Responsible for scheduling and rescheduling patient appointments and communicating with patients and therapists about changes in schedule.
6. Accurately discharges patient accounts and their charts.
7. Assembles new patient charts, obtaining previous PT charts from Medical Records as needed. Ensures records are complete and appropriate documents are scanned into SRS, including evaluations, progress notes, and physician correspondence.
8. Communicates with insurance carriers to verify benefits and/or obtain authorization for physical therapy benefits/services. Enters required information regarding benefits into the HMR.
9. Tracks treatment service authorizations and submits requests for additional services as necessary.
10. Ensures proper completion of patient history forms.
11. Organizes billing sheets from previous day and ensures accuracy and completeness before submission to business for charge entry.
12. Maintains communication with referring physicians, insurance providers and therapy staff to help ensure continuity of care.
13. Prepares daily reports to include number of patients seen/units billed for outpatient PT, and number of patients seen for Inpatient Therapy.
14. Verifies all therapy patients have appropriate diagnosis for each plan of care to support medical necessity, insurance is pre-certified if necessary, and obtains a commitment for payment arrangements from patient when necessary prior to therapy.
15. Works closely and professionally with referring providers when therapy needs to be done and/or is denied reimbursement to help the provider get all paperwork in order to start the authorization process, prove medical necessity, and/or retroauthorization.
16. Works directly with Billing Office in denials and/or collections as well as month end and month opening procedures.
17. Responsible for knowing hospital policies and being familiar with hospital services that are available.
18. Demonstrates an ability to be flexible, organized and function well in stressful situations.
19. Demonstrates ability to multitask efficiently.
20. Treats patients and their families with respect and dignity; ensures confidentiality of patients’ records.
21. Maintains a good working relationship both within the department and with other departments.
22. Participates in the educational program, completes annual educational requirements, and attends in-service meetings as required.
23. Attends all meetings as required.
24. Maintains patient confidentiality at all times.
25. Must maintain accurate time clock punches, punch in and out according to hospital policy.
26. Answers incoming calls to the facility in a professional, timely manner.
27. Accepts and completes other duties as assigned or requested.
28. The employee is required to comply with all PCI standards and other company policies and procedures for payment card acceptance and security. ABOUT MOUNTAIN VIEW: Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice. Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

Qualifications

Education/Certification: High school diploma or general education degree (GED). Experience: One to three months related experience and/or training; or equivalent combination of education and experience. Equipment/Technology: Ability to use hospital information system, and operate basic computer functions and software.

Good working knowledge of Microsoft Office is a plus. Language/Communication: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Employee must posses the ability to speak effectively, before groups of customers and or employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Employee must posses the ability to compute rate ratios and percentages and to draw and interpret bar graphs.