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Insurance Specialist / HHC at Home SSO PAS

Requisition ID:

20162729

Business Unit:

Hartford HealthCare Corp.

Location:

Newington, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details:

Work where every moment matters. 

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. 

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary/Responsibilities:

  1. Compiles financial data required to verify accuracy of client’s fee source/method of payment to assure timely reimbursement. Obtains initial and ongoing authorization for services as appropriate. Documents payor source data and authorization activity to online billing system.
  2. Works closely with supervisor and/or client care coordinator to assure accuracy of fee source data. Promptly enters the verified payor data into billing system.
  3. Contacts insurance and managed care companies to investigate coverage and obtain pre-authorization for initial and continuing services. Documents on appropriate forms or online and communicates authorization status to appropriate staff.
  4. Initiates process of insurance verification for all payor revisions. Verifies benefit coverage for services requested, secures authorization/documentation requirements specific to the payor and ensures accuracy of payor data via investigation.
  5. Runs authorization reports daily to monitor status. Identifies and pursues receipt of all expiring authorizations. Reports and follows through on receipt of authorizations which require clinical intervention.
  6. Oversees status of activity related to capitated reimbursement fee sources. Once cap has been met, initiates revision of payor source data as necessary
  7. Works closely with scheduling/team members to eliminate visit occurrence when necessary pre-authorization for services has not been obtained. If non-authorized visit should occur, issue must be identified and resolved within 24 hours of visit. Reports any unauthorized care to billing department monthly.
  8. Informs clients/referral sources of Agency product lines
  9. Confers with clients as needed in relation to alternative fee sources/funding. Completes financial assessment to determine eligibility. Notifies clients by phone of their financial responsibility (i.e. co-pays)
  10. Recommends eligibility for government program(s) or subsidy(s). Refers to Financial Review Committee for action or application. Select individual(s) from each region will be expected to participate in Financial Review Committee.
  11. Audits financial data forms and insurance investigations for completeness and accuracy. Makes timely corrections to data as necessary. Provides regular feedback and education to Central Intake regarding incomplete or inaccurate data collection at time of referral. 
  12. Negotiates billing rates within Agency-established guidelines.
  13. Provides reimbursement-related education to designated teams via IDT
  14. Monitors, analyzes, and reports trends identified regarding authorization and/or documentation requirements.
  15. Must possess strong knowledge related to Governmental reimbursement regulations, stays current of changes to policy, and educates staff timely.
  16. Actively participates in record audits involving reimbursement associated compliance matters. Reports results to team. 
  17. Provides regular monitoring and reporting of payor changes to the Billing Dept. Communicates to care management teams concerning system tasks such as automatic payor change and month-end processing activities.
  18. Processes regulatory documents in accordance to agency procedures and timeframes – Track Hospice certificate of Terminal Illness(mail, fax, and tracking of receipt by spreadsheet within 7 days)

Qualifications

Education: High School diploma or equivalent; two years college education preferred; LPN preferred.

Experience: Two years experience in coverage verification/benefit determination. Knowledge of governmental reimbursement criteria. Knowledge of third party/managed care contracts related to Agency services is preferred.

Skills: Computer literate. Experience with Agency’s current software platform(s) preferred.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

 
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