Senior Insurance Clearance Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Acquire and maintain up-to-date knowledge of payor requirements, as well as Federal and State regulations, authorizations, and hospital billing processes.

• Conduct insurance authorization for both inpatient and outpatient services by gathering and analyzing clinical data in accordance with payor guidelines.

• Identify the appropriate procedure codes for authorization to guarantee suitable reimbursement.

• Consult with patients and various departments regarding uninsured status, uncovered services, out-of-network status, Third Party Liability, and Workers Compensation issues.

• Communicate with patients when authorization is not secured, explaining potential financial responsibilities.

• Verify eligibility and authorization through dedicated computer software programs.

• Identify and notify Primary Care Physicians regarding HMO coverage.

• Recognize at-risk balances associated with Medicaid eligibility regulations and liaise with Financial Counseling, Utilization Management, and physicians.

• Complete cancellations and accurately reschedule patient appointments.

• Handle incoming and outgoing calls to complete the patient pre-registration process.

• Pre-register and register patients following established computer-entry procedures.

• Accurately enter patient demographic and insurance details into the ADT system.

• Generate and process necessary registration documents while educating patients about required signatures.

• Participate in staff meetings, continuing education, mandatory in-services, safety training, skill competencies, and group projects.

• Respond to or appropriately refer inquiries from patients, visitors, and employees.

• Uphold patient record confidentiality by adhering to HIPAA and compliance policies.

⛳️ Requirements

• High School Graduate.

• Generally requires 2 years of experience in healthcare, the insurance industry, a call center, or a customer service environment.

• Licensure, Registration, and/or Certification: None required.

• Ability to problem-solve in a high-pressure and demanding environment.

• Capability to prioritize and organize workload effectively.

• Strong mathematical aptitude, effective communication, and critical thinking skills.

• Basic understanding of human anatomy and medical terminology.

• Excellent verbal and written communication abilities.

• General computer proficiency.

• Must be able to sit for most of the workday.

• May involve occasional light travel.

• Ability to operate all necessary equipment to perform the job effectively.

🏝️ Benefits

• Eligible for benefits.

• Premium pay options such as shift differentials, on-call pay, and more, depending on the teammate's role.

• Incentive pay available for select positions.

• Opportunities for annual salary increases based on performance.

• Paid Time Off programs.

• Comprehensive medical, dental, vision, life, and Short- and Long-Term Disability benefits.

• Flexible Spending Accounts for eligible healthcare and dependent care expenses.

• Adoption assistance and paid parental leave offered.

• Defined contribution retirement plans with employer matching.

• Additional financial wellness programs.

• Educational Assistance Program available.