Jr Insurance Benefits Analyst (Per Diem)
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Cape Cod Healthcare
Hyannis, MA, US
Summary
The role involves verifying insurance eligibility, managing referrals, and resolving billing errors to ensure timely claim submission. Additionally, the analyst supports process improvement initiatives and provides quality control assessments for patient access staff.
Job Description
- Troubleshoot and evaluate work product of staff, make recommendations to management and assists with implementing changes.
- Participate with management in strategizing for Process Improvement initiatives to improve cash flow.
- Attend and participate in management meetings.
- Assists management on special organizational projects for CCHC.
- Provide input and feedback for employee evaluations.
- Work collaboratively with Patient Access Managers, Scheduling Managers, Business Office Managers, Vendors and Customers across the enterprise to ensure that Registrars and Schedulers are fully capable of using technology to properly register our patients.
- Assists with review of financial clearance and registration procedures and ensure effective communication with physician practices, patients and internal departments.
- Work with department managers to continuously identify and correct issues identified by reporting.
- Assist Patient Access Managers with Quality Control assessments of their staff related to eligibility and pre-registration errors.
- Verifying insurance eligibility using available technologies, payer websites, or by phone contact with third party payers. Working in accordance with required State and Federal regulations and CCHC policies.
- Contact patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
- Ensure correct insurance company name, address, plan, and filing order are recorded in the patient accounting system.
- Processes outgoing referrals to specialists outlined by the patient’s insurance plans in a timely manner.
- Utilize payer websites and/or Epic/Experian to process, obtain and verify insurance referrals.
- Utilizing the incoming referral work queue will request, obtain and link insurance referral authorizations to upcoming specialty appointments as outlined by the patient’s insurance plan in a timely manner.
- Track, document and communicate the status of referrals as they move through the referral process, ensuring proper follow-up, documentation and communication when the referral has been completed.
- Maintain core competency and current knowledge of regulatory payer authorization and eligibility requirements.
- Obtain and verify authorizations to ensure payment for services provide through CCHC.
- Work accounts in assigned work queues to resolve billing errors and edits to ensure all claims are filed in a timely manner.
- Follow-up and work registration/authorization claim denial work queues to identify and take the appropriate action to fix errors for claim resubmission to payers.
- Maintain close coordination with Practice Managers, Clinical/Front End staff, and Physicians to advise of any changes or updates to insurance payer requirements.
- Responds to all practice inquiries and questions about insurances, referrals, and authorizations.
- Meets and maintains daily productivity and quality standards established in departmental policies.
- Assists the department, work unit and/or fellow staff members by cross-covering for absences, participating in special projects, and attending ongoing training sessions, etc.
- Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.
- Ability to work with minimum supervision and in a team environment.
- Performs other job-related duties and assignments as requested/directed.
- Demonstrates the ability to adjust to unexpected changes to assure all responsibilities/duties are met during absences or increases in work volume.
- Associate Degree strongly preferred, High School diploma or GED required
- Minimum of one (1) year experience in a large hospital’s Revenue Cycle Department with an emphasis on Patient Access and or Scheduling is strongly desired.
- Experience with large hospital information systems is required, preferably Epic and/or Siemens is preferred.
- Excellent interpersonal, problem solving and critical thinking skills
- Excellent PC skills with a strong emphasis on the Outlook suite of products
- Excellent verbal and written communication skills are required.
- Medical Terminology knowledge preferred
- Experience utilizing insurance payer websites preferred.
Cape Cod Healthcare is the leading provider of healthcare services for residents and visitors of Cape Cod. With more than 600 physicians, over 5,000 employees and over 250 volunteers, Cape Cod Healthcare is comprised of two acute care hospitals, a Level III trauma center, the Cape’s leading provider of homecare and hospice services (VNA), seven urgent care centers, a primary and specialty care network, a skilled nursing and rehabilitation facility, an assisted living facility, and numerous health services and programs.
We are committed to achieving and maintaining the highest standards in healthcare by partnering with other health and human service providers and continuing to invest in new technologies. By offering services like imaging and radiology, heart and vascular care, surgical services, orthopedics and urgent care, Cape Cod Healthcare provides access to exceptional medical services across the Cape.
For over a century, we have never wavered from our mission: To coordinate and deliver the highest quality, accessible health services, which enhance the health of all Cape Cod residents and visitors.
Founded
1916
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Hyannis, MA
Cape Cod Healthcare is the leading provider of healthcare services for residents and visitors of Cape Cod. With more than 600 physicians, over 5,000 employees and over 250 volunteers, Cape Cod Healthcare is comprised of two acute care hospitals, a Level III trauma center, the Cape’s leading provider of homecare and hospice services (VNA), seven urgent care centers, a primary and specialty care network, a skilled nursing and rehabilitation facility, an assisted living facility, and numerous health services and programs.
We are committed to achieving and maintaining the highest standards in healthcare by partnering with other health and human service providers and continuing to invest in new technologies. By offering services like imaging and radiology, heart and vascular care, surgical services, orthopedics and urgent care, Cape Cod Healthcare provides access to exceptional medical services across the Cape.
For over a century, we have never wavered from our mission: To coordinate and deliver the highest quality, accessible health services, which enhance the health of all Cape Cod residents and visitors.
Founded
1916
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Hyannis, MA
