Job Details

Insurance Specialist

Location: Avera Downtown Building-Sioux Falls

Worker Type: Regular

Work Shift: Day Shift (United States of America)

Pay Range: $19.50 - $25.50

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

What You Will Do

• Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
• Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care.
• Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into the health information system.
• Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information.
• Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator to determine estimated patient responsibility and communicates financial expectations to the patient.
• Educates patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered, and identifies methods of payment available. Identifies patients in need of financial assistance and provides charity applications and referrals to the business office as necessary.
• Responsible to screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. Assure all payer requirements are met, including non-coverage waivers, Advance Beneficiary Notices, sterilization forms, and other forms as applicable.
• Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff.
• Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.

Essential Qualifications

• The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• 1-3 years Related experience in billing, insurance or registration.
• 1-3 years Healthcare experience

Preferred Education, License/Certification, or Work Experience:

• Associate's finance, business or healthcare.

Expectations and Standards

• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera's values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.