Set your sights on a role making a real difference in the healthcare system. We’re looking for a self-motivated Patient Access Insurance Specialist to join our team. We have a relentless focus on driving results for our customers and enabling them to invest more into patient care; in turn, this allows us to continue to grow our company and your career.
The primary focus for this role is to mitigate the financial risks to our hospital clients. To do this this position is responsible for contacting patients directly and/or using alternative means to secure patient’s information such as demographics, insurance/coverage and clinical information needed to determine patient’s eligibility, coverage, and insurance limitations. Patient Access Insurance Specialist will use analytical skills to make decisions and explain coverage details so that patients completely understand what their financial responsibility will be. Associates in this role are empowered to identify additional resources and refer patients who might have difficulty meeting their financial responsibilities.
Your day to day role will include:
- Obtains appropriate eligibility and benefit information using various phone and online resources.
- Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.
- Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.
- Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.
- Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
- Immediately refers 'at risk' admission to eligibility, i.e., out of network, underinsured, max benefits, etc.
- Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.
- Maintains a satisfactory level of performance and adherence to workload standards.
- Interprets 271 response, including insurance terminology in online tool to determine patient responsibility.
- Performs calculations using insurance benefit information to accurately estimate patient responsibility
- May lead and/or train new employees in account preparation and review functions
- High School diploma or equivalent.
- Capacity to manage shifting priorities in a time sensitive environment
- Strong organizational skills
- Customer Service
- Ideal candidate will possess exceptional verbal and written communication skills with the ability to interface across all levels, both internal and external in nature
It would be great if you also have:
- Basic Word/Excel
- Medical terminology
- Prior experience with Summary Plan Descriptions
R1 is changing healthcare by infusing operational discipline and proprietary technology in hospital financial processes. We are an industry leader; we are the only independent organization with a comprehensive service and technology offering for hospital revenue cycle management, and we have achieved leading outcomes for our customers.
- A strong financial performing, growing organization that will keep you on your toes with new ideas, changes and opportunities to learn and grow in abundance.
- A culture of excellence, driving customer success so they can focus on improving patient care and on giving back to the community.
- A Total Rewards package which may include such things as: competitive compensation package, the ability to choose from a comprehensive benefit program mostly funded by R1 that includes medical, dental, vision, flexible spending accounts, commuter benefits, life and disability insurance, along with work life balance programs including paid time off for personal time, illness and volunteering, and we offer a retirement savings plan and continuing training and development and so much more!
Sound like you? Let’s talk!
R1 is a leading provider of revenue cycle management services and Physician Advisory Services to healthcare providers. We are the largest independent end-to-end revenue cycle provider and have the longest operating history in the revenue cycle industry. R1’s objective is to be the one trusted partner to manage revenue so providers and patients can focus on what matters most. Our distinctive operating model and values includes people, processes, and sophisticated integrated technology/analytics that help customers realize sustainable improvements in their operating margins and improve the satisfaction of their patients, physicians, and staff. We are dedicated to transforming the commercial infrastructure and patient experience in healthcare.