Patient Access Insurance Coordinator

The Coordinator is responsible for determining the status of a patient’s insurance eligibility/coverage by contacting the appropriate insurance or third party payor in accordance with Shriners Hospitals for Children policies and procedures, for assigned facilities. The Coordinator may also be called upon to assist assigned facilities with resolving their patient access edits in the bill scrubber. The Insurance Coordinator will have a thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid and Medicare payor guidelines and eligibility criteria.

Key Responsibilities:

Performs insurance verification functions for assigned SHC facilities.

• Updates encounters in SHCIS with the appropriate eligibility and COB status.

• Documents, in the health plan comment field on the encounter, all actions that have been taken on the account related to insurance verification.

• Updates health plan as needed based on feedback from the insurance company.

• Maintains a detailed level of knowledge of all payors’ authorization/referral guidelines and updates all appropriate fields in SHCIS to drive encounters to worklists

• Maintains a daily productivity log.

Performs bill hold review for assigned facilities.

• Reviews assigned bill hold worklists in the bill scrubber and updates the SHCIS encounter to resolve the bill hold and release the claim

• Documents, in the health plan comment fields on the encounter, all actions that have been taken to resolve the bill hold

• Documents, in the bill scrubber, the action that was taken to resolve the bill hold and assigns back to the CBO

• Maintains a daily productivity log

Plans and organizes the work and activities of area of responsibility to ensure department and corporate goals are met

• Coordinates and prioritizes assigned activities to achieve maximum productivity

Makes recommendations to the Corporate Manager of Patient Access for quality and efficiency improvements.

• Identifies system issues, assists in identifying root causes of issues and submits recommendations to the Corporate Manager of Patient Access and IS department for resolution

Completes special projects as directed by the Corporate Manager of Patient Access.

Demonstrates a positive and professional image at all times when interacting with management, staff and others.

• Responds positively to necessary changes in the workplace

Assumes responsibility for professional growth and development.

• Attends workshops and seminars, reads manuals and updates to maintain a high level of knowledge of all payor criteria

• Maintains professional competency, according to department policies, procedures and protocols

This is s remote position with a schedule of Monday thru Friday 8AM - 5PM ET.

Required Qualifications:

• 3 years of insurance verification and authorization experience

• 3 years of medical billing and utilization experience

• Strong Epic registration and scheduling experience

• Competency in MS Office

• High School Diploma / GED

Preferred Qualifications:

• 3 years of experience working as an insurance verifier in an acute care hospital, physician practice setting or other healthcare setting

• Children's hospital experience