Eligibility Insurance Specialist

JOB SUMMARY

Work Location: Valley Baptist

Shift Information: Monday-Friday 8a-4:30p

Spanish Required

The Insurance Specialist is tasked with identifying candidates for the Health Insurance Premium Payment (HIPP) program.  In addition to assisting with identifying the potential candidates, other responsibilities will include assistance with enrollment, working closely with family and the agency through the enrollment process; identify all sources for payment, documenting accounting system including progress notes and all required activities to ensure accurate reporting and following the case through the approval process. This individual will work closely with the EES onsite teams to coordinate the patient’s application process

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

1. Performs an in-depth analysis of all inventory identified as eligible.  The analysis includes, but not limited to review of patient’s demographics, payor data review, understanding payor methodology, commercial vs. government payor structures.  Working knowledge of chronic illnesses, researching and understanding of diagnosis and patient’s prognosis, reviewing medical records as necessary to determine eligibility 
2. Develop a working relationship with patient and/or family through application process for completion and follow-through of each case.   Working closely with State agencies to facilitate case approval, filing appeals as necessary.  Contacting patient’s employer HR department and/or insurance company to gain knowledge on insurance fee structure 
3. Secures all required forms and data for the program, develops working relationship with MECS Director, Social Workers and Case Management, PA Directors as needed to communicate progress on the application status as well challenges with the case and how it may affect the payor outcome.   Understanding of revenue reclassification 
4. Follows up on all assigned inventory timely according to documentation and follow-up guidelines.  Documents thoroughly, applies all necessary codes to ensure accounts are captured correctly through our reporting. Once approval is obtained ensures coordination of benefits are correctly documented and verified 
5. Works closely with management team to continue the development of the program  

SUPERVISORY RESPONSIBILITIES 

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Working familiarity with the rules and regulations pertaining to Federal, State and County programs
• P/C systems literate including Windows, and Micorsoft Outlook, Excel and Word programs
• Ability to work independently
• Excellent oral and written communication skills, as well as the clear understanding of the English language
• Detail oriented, with strengths in dealing with multiple facilites, Supervisors, and Hospital platforms
• Ability to prioritize and manage multiple tasks with efficiency
• Valid Drivers License and auto insurance

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School Diploma or equivalent
• Minimum 2 years of work experience in the medical field
• Knowledge of Medical terminology 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel 
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Office or Hospital Work Environment

TRAVEL

• Approximately 10% travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!