Hybrid Insurance Specialist (TEMP) bei Cape Cod Hospital

·       Responds to incoming calls regarding insurance authorizations, information requests, and denials.

·       Regularly updates knowledge of third party payor regulations, and updates staff in writing of any changes as they become known.

·       Verifies insurance pre-authorization/certification for services, including number of visits approved and dates that services are covered.

·       Accurately completes insurance tracking sheet for each patient and each discipline.

·       Tracks insurance caps and ensures that patient treatment does not exceed monetary allowance as outlined by insurance company; notifies patient and therapist of insurance caps.

·       Acts as liaison between patients and clinicians regarding authorization and usage of visits.

·       Follows through on requests for information within 24 hours

·       Recognizes referral errors and makes corrections as needed.

·       Compiles and submits appeal letters on receipt of denial.

·       Obtains and submits information to resolve denials.

·       Consistently ensures documentation received for extension approvals are in the medical record on the date received and communicated to the patient to ensure no interruption in care.

·       Provide accurate and comprehensive information about all third party payors and requirements for authorized visits.

·       Performs the basic duties of the Rehab Department secretary to cover brief absences.

·       Communicate clearly and tactfully with patients and their families, maintaining confidentiality at all times.

·       Attends departmental meetings as required.

·       Acts as a resource and support person for front office staff.

·       Perform other work related duties as assigned or requested. 

Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital's commitment to CARES: compassion, accountability, respect, excellence and service.

• Ability to read, write and communicate in English.

·       High school graduate or equivalent.

·       Two years experience in a medical or rehab office, clinic, or comparable hospital experience utilizing insurance company websites required.

·       1 year experience working with third party payors including referral and authorization requirements.

• Successful passage of basic medical terminology course OR successful passage of the CCH Medical Terminology exam. 
• Keyboarding skills at 35 WPM as demonstrated by successful passage of a timed test.
• 1 year experience with hospital, clinical or medical office based information system.
• Basic mathematics skills and ability to apply skills, as demonstrated by successful passage of a timed business math test, using manual and aided computations to solve problems.