About the role
Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better.
Title: Per Diem (as needed) Insurance Reimbursement Specialist - Physical Therapy - Northern Dutchess Hospital - Rhinebeck, NY
Summary:
The Insurance Specialist is responsible for coordination and support of initiatives relative to the evaluation, processing, and handling of insurance verification/authorizations and patient benefits. Acts as a liaison between the insurance providers and agents, claimants, and policy holders regarding the status and eligibility for coverage for rehab services.
Responsibilities:
1. Performs insurance eligibility verification/authorization and executes payor requirements as needed. Includes initiating eligibility transactions to obtain necessary billing information and authorization, referrals for service when appropriate.
2. Obtains and understands necessary clinical information (including diagnoses) to initiate requests for authorizations.
3. Ensures that proper selection of insurance, plan type, financial obligations, pre-certification and billing address are assigned in the system.
4. Communicates and updates all information in medical record pertaining to patient’s financial obligations to individual therapy sites, clinicians and billing office to ensure all therapy treatments are authorized. This includes but not limited to copayments, deductibles, self-pay rates, in-and-out of network responsibilities, referrals, authorizations and other information as needed.
5. Answers patient inquiries regarding their liability and able to explain variables involved and assists in mitigating any issues or barriers that may come up. Determines need for financial counseling and directs patient to appropriate Nuvance Health resources.
6. Collaborates with business office, clinical teams and patient for the denial and appeals process, as necessary.
7. Maintains communication with System departments (e.g., managed care, SBO, FCC) to identify any changes, trends, or updates to existing or new contracts the System may have with an insurance company.
8. Serves as back-up to other administrative functions as needed to include registering patients, scheduling patients, managing front desk operations (answering phones, collecting co-pays, etc..) and tracking plans of care.
9. Performs other duties as assigned
10. Ability to travel between outpatient sites, as assigned, based on coverage needs.
Education Skills Experience:
Required: Essential: * HS Graduate or Equivalent.
Customer service and organizational skills.
Data entry experience and good phone etiquette required.
Knowledge of database management and ability to problem-solve.
Desired: Minimum of one year of healthcare office experience.
Other Information:
Experience with medical terminology, medical coding, billing procedures, medical records.
Basic knowledge of payor guidelines.
Salary Range: $19.54 - $37.94 Hourly
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