Patient Access Insurance Coordinator

Overview Under the leadership of the Corporate Patient Access Manager, the Patient Access Insurance Coordinator is an active member of the Patient Financial Services and Patient Access team that delivers support that is consistent with the strategic vision, goals, philosophy and direction of Shriners Hospitals for Children. The Patient Access Insurance Coordinator is responsible for determining the status of a patient’s insurance eligibility/coverage by contacting the appropriate insurance or third party payor in accordance with Shriners Hospitals for Children policies and procedures, for assigned facilities. The Insurance Coordinator may also be called upon to assist assigned facilities with resolving their patient access edits in the bill scrubber. The Insurance Coordinator will have a thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid and Medicare payor guidelines and eligibility criteria. This is a remote position; typical schedule 8:30am-5:00pm. Responsibilities Under direction from the Corporate Patient Access Manager, performs insurance verification functions for assigned SHC facilities. Updates encounters in SHCIS with the appropriate eligibility and COB status. Documents, in the health plan comment field on the encounter, all actions that have been taken on the account related to insurance verification. Updates health plan as needed based on feedback from the insurance company. Maintains a detailed level of knowledge of all payors’ authorization/referral guidelines and updates all appropriate fields in SHCIS to drive encounters to worklists Maintains a daily productivity log. Under direction from the Corporate Patient Access Manager, performs bill hold review for assigned facilities. Reviews assigned bill hold worklists in the bill scrubber and updates the SHCIS encounter to resolve the bill hold and release the claim Documents, in the health plan comment fields on the encounter, all actions that have been taken to resolve the bill hold Documents, in the bill scrubber, the action that was taken to resolve the bill hold and assigns back to the CBO Maintains a daily productivity log Plans and organizes the work and activities of area of responsibility to ensure department and corporate goals are met Coordinates and prioritizes assigned activities to achieve maximum productivity Makes recommendations to the Corporate Manager of Patient Access for quality and efficiency improvements. Identifies system issues, assists in identifying root causes of issues and submits recommendations to the Corporate Manager of Patient Access and IS department for resolution Completes special projects as directed by the Corporate Manager of Patient Access. Demonstrates a positive and professional image at all times when interacting with management, staff and others. Responds positively to necessary changes in the workplace Assumes responsibility for professional growth and development. Attends workshops and seminars, reads manuals and updates to maintain a high level of knowledge of all payor criteria Maintains professional competency, according to department policies, procedures and protocols This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned. Qualifications Required: 3 years of insurance verification, insurance authorization experience 3 years of medical billing and utilization experience Strong Epic registration and scheduling experience Competency in MS Office High School Diploma / GED Preferred: 3 years of experience working as an insurance verifier in an acute care hospital, physician practice setting or other healthcare setting Children's hospital experience Shriners Children’s is an EOE/Drug-Free, Smoke-Free Workplace.