Senior Insurance Clearance Representative

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $22 - $34 / hour

⏰ Full Time

🟠 Senior

🔒 Insurance

👻 Ghost score 0%

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Advocate Aurora Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $10.2M Grant on 2019-08

Healthcare • Healthcare Insurance

Advocate Aurora Health is a leading healthcare organization that operates across various regions including Central Chicagoland, Central Wisconsin, Greater Milwaukee, and more. With a diverse range of career areas such as advanced practice clinicians, behavioral health, nursing, and more, Advocate Aurora Health is committed to helping people live well. The organization offers numerous benefits and opportunities for career advancement, fostering an environment where individuals can thrive and innovate in the healthcare sector. Advocate Aurora Health prioritizes the safety of its candidates and maintains a robust recruitment process to protect sensitive information.

📋 Description

• Serve as the main point of contact for internal and external customers • Assist patients and providers with coordination of care • Support preservice activity and perform insurance authorization clearance functions • Identify and evaluate benefits and consult with patients and providers regarding authorization status • Collect and analyze clinical data according to payor guidelines to obtain prior authorization • Maintain current knowledge of payor authorization, billing requirements, and Federal and State regulations • Perform insurance authorization for inpatient and outpatient services • Determine appropriate procedure codes for authorization and reimbursement • Consult on uninsured status, uncovered services, out-of-network status, Third Party Liability, and Workers Compensation situations • Communicate with patients when authorization is not obtained and explain potential financial responsibility • Verify eligibility and authorization using stand-alone computer software • Identify and notify Primary Care Physicians for HMO coverage • Identify at-risk balances related to Medicaid eligibility and communicate with Financial Counseling, Utilization Management, and physicians • Complete cancellations and accurately reschedule patients • Manage incoming and outgoing calls and complete patient pre-registration • Pre-register and register patients using established computer-entry procedures • Enter accurate patient demographic, insurance, benefit, eligibility, and authorization data in the ADT system • Generate and process registration documents and educate patients about required signatures • Participate in staff meetings, continuing education, mandatory in-services, skill competencies, and group problem-solving projects • Answer or appropriately refer patient, visitor, and employee questions • Maintain patient-record confidentiality by following HIPAA and compliance policies

🎯 Requirements

• High School Graduate • Typically requires 2 years of experience in health care, insurance industry, call center, or customer service setting • Ability to problem solve in a high profile and high stress area • Ability to prioritize and organize workload • Mathematical aptitude, effective communication, and critical thinking skills • Understanding of basic human anatomy and medical terminology • Excellent verbal and written communication skills • General computer knowledge • Must be able to sit most of the workday • May include intermittent light travel • Operates all equipment necessary to perform the job • No licensure, registration, or certification required

🏖️ Benefits

• Benefits eligible • Premium pay such as shift, on call, and more based on a teammate's job • Incentive pay for select positions • Opportunity for annual increases based on performance • Paid Time Off programs • Medical, dental, vision, life, and Short- and Long-Term Disability benefits • Flexible Spending Accounts for eligible health care and dependent care expenses • Adoption assistance and paid parental leave • Defined contribution retirement plans with employer match • Other financial wellness programs • Educational Assistance Program • Career development and well-being programs