Insurance Verification & Eligibility Specialist

Program/ Location: Admissions Department/ New Bedford
Education: High School diploma or equivalent (GED)
Pay Range: $22 - $29 per hour (Education & experience dependent)
Status: Full Time

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Long & short term disability
• Discounted auto/home and renters insurance
• 403b - Retirement
• FSA & DSA
• PMLA
• Employee Assistance Program
• Bonuses & Referral
• Eligibility for free classes to become a Licensed Counselor or Recovery Coach
• Education days to use towards CEU's
• Free meals at select programs and when available
• Unmatched Leave Time (FT employees can earn up to 3 weeks in first year)

About Us

High Point & Affiliated Organizations is a health and human service agency whose mission is to treat and prevent substance use disorders and mental illness. High Point has programs located throughout Southeastern Massachusetts offering a full continuum of care for substance use and mental health treatment, including inpatient, outpatient, residential, and community-based services. Programs and services also assist survivors of abuse, violence, and families experiencing homelessness. High Point believes that everyone has inherent goodness, worth, and dignity. Our goal is to help individuals and families achieve personal change and improve their quality of life.

Insurance Specialist Requirements

• Demonstrates flexibility and ability to perform multiple tasks
• Must have excellent verbal and written communication skills, including the ability to organize ideas in logical and clear fashion
• Proficient and knowledge of basic computer skills and software programs including the HPAO`s electronic health record and Microsoft Office applications (Word, Excel, and Outlook)
• Must have the ability to work with others in cooperative and collaborative manner
• An understanding of boundaries and ethics
• Comply with Federal Regulations, 42 CFR Part 2, Substance Abuse Confidentiality Regulations and HIPAA Regulations
• Demonstrates ability to work with the alcoholic/ chemical dependent population as well as the mental health population.
• Experience in the medical/substance abuse/mental health field in a Front Desk or Insurance Verification role
• Knowledge and understanding of how to identify the correct Insurance from reviewing an insurance card and/or website verification
• Motivated and enthusiastic team player
• Strong organizational skills with great attention to detail
• Positive interpersonal skills and professional demeanor

Insurance Specialist Duties & Responsibilities

• Verification of insurance coverage prior to or immediately upon admission
• Verification of insurance benefits, coverage of potential services and provide patient cost estimate
• Work with insurance companies to obtain necessary authorization for services and/or level of care if applicable
• Maintain current knowledge of payer policies, current contracts, and requirements
• Answer requests from patients, payors, and/or other departments related to coverage of services and/or prior authorizations
• Resource to HPTC employees and other departments related to insurance benefits and prior authorizations
• Maintain HIPAA compliance
• Verify insurance eligibility, benefits, copays/deductibles utilizing TriZetto/POSC verification platform, insurance carrier websites, and/or calling the insurance carrier
• Review Insurance eligibility to identify non-participating insurance carriers to ensure proper notification is provided to the patient and necessary departmental staff
• Enter insurance information into the Electronic Health Record and notate any special billing/authorization needs apply
• Perform insurance entry audits and provide feedback to staff if applicable
• Assist in any special projects or duties assigned by Supervisor

Insurance Specialist Qualifications

• Minimum of a high school diploma or equivalent GED
• Insurance verification: 2-5 years (Required)
• Insurance billing: 2-5 years (Required)
• Prior Authorization and appeals: 2-5 years (Recommended)