Patient Access Insurance Coordinator

Company Overview

#LI-Remote

Shriners Children’s is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical, dental and vision coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a full-time or part-time status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans. Additional benefits available to full-time and part-time employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Job 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, delivering support that is consistent with the strategic vision, goals, philosophy and direction of Shriners Children's. 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 Children's 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. 

Responsibilities

Under direction from the Corporate Patient Access Manager, performs insurance verification functions for assigned Shriners Children's 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

Minimum:

• 3 yrs of experience with insurance verification, authorization, medical billing and utilization
• Proficiency in MS Office
• Epic registration and scheduling experience
• High School Diploma/GED

Preferred:

• Experience working in a children's hospital