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Rogers Behavioral Health · 3 weeks ago

Benefit Verification Specialist I (Oconomowoc)

Oconomowoc, WI

Full-time

Onsite

Entry Level

1+ years exp

Rogers Behavioral Health is seeking a Benefit Verification Specialist I to ensure that patient care teams have a clear understanding of behavioral health insurance benefits. The role involves verifying benefits, determining patient financial responsibility, and communicating coverage information to support admissions and claims.

Addiction TreatmentHealth CareHealth DiagnosticsMedicalMental Health

Responsibilities

Verify behavioral health insurance benefits for patients and potential patients

Spend significant time on the phone and online with insurance and managed care companies to confirm behavioral health coverage, limitations, referrals and authorization requirements

Use online payer portals as well as facility resources, managed care grids to accurately receive, interpret, and document benefit information as required

Accurately document quote of benefit details in Cerner, using correct dropdown selections, updating required fields, and assigning items to follow-up worklists as appropriate

Maintain high-level multitasking by actively working in multiple systems at once, verifying benefits, completing portal checks, correcting registration or demographic errors, and documenting results in Cerner, all while navigating multiple monitors and continuing productive work during insurance hold times

Audit demographic, insurance and financial data daily to ensure accuracy for encounters

Communicate with admissions, care coordination and utilization review teams to ensure accuracy of accounts Identify potential coverage issues and escalate appropriately to avoid admission delays

Knowledge of Rogers programs and the facility’s admission, insurance authorization, and billing processes

Support departmental goals and team development

Participate in daily peer audits and huddles, providing and receiving constructive feedback in a professional manner

Maintain up-to-date knowledge of behavioral health payer policies, authorization requirements, and facility programs

Support patients and internal teams by addressing benefit-related questions promptly and accurately

Contribute to training efforts, uphold department policies and procedures, and demonstrate punctuality, professionalism, and teamwork

Apply good practice principles to job duties

Use good communication skills and tact to deal effectively with third-party carrier representatives, and all other team members internally and externally

Use common sense in situations and respond appropriately in all communication modes (body language, verbal) to everyone, regardless of his/her/their behavior

Maintain a calm attitude and create a conducive atmosphere in difficult situations

Work cooperatively and supportively with all

Remain courteous and respectful to others during work interactions and be willing to work out problems on a one-on-one basis

Complete assignments and documentation on time

Take responsibility for and manage day-to-day problems, including completion of all documents

Complete other duties as assigned by the supervisor of Benefit Verification team

Promote department goals and the Mission of Rogers Behavioral Health

Communicate goals to fellow staff members

Demonstrate measurable goal achievement

Maintain department policies and procedures

Include requirements and guidelines from external agencies (State of Wisconsin, Joint Commission)

Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed

Demonstrate acceptance and training of student interns in the department, as directed

Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations

Involve self in the learning and application of standards relevant to Admission Services

Participate in in-services, seminars, and other meetings to increase involvement and awareness of regulations

Involve self in the education of other disciplines regarding Admission Services’ regulations

Participate in Rogers committees, Rogers Improvement System (RIS) team meetings and team projects, as directed

Demonstrate punctuality and preparedness

Demonstrate effective communication skills and good organizational skills

Contribute in a positive, solution-focused manner

Demonstrate willingness to complete tasks/responsibilities related to projects (i.e., audits, tracking data, etc.)

Conduct self in a professional manner

Demonstrate organizational skills that promote timely response to all inquiries and to task completion

Communicate with all individuals in a positive and professional manner

Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution

Communicate concerns and provide solutions for same

Attend outside seminars to promote professional growth

Demonstrate a positive and professional attitude toward parties outside Rogers (patient families, visitors, vendors, etc.)

Comply with the Hospital’s policies and procedures, including Human Resources, Infection Control and Employee Health policies and programs

Project a professional image by wearing appropriate, professional attire

Qualification

Insurance verificationCernerBehavioral health benefitsMicrosoft OfficeMultitaskingHIPAA complianceCommunication skillsProblem-solving skillsAttention to detail

Required

High school diploma required

Ability to be flexible with work assignments, including schedule changes, caseload volume changes, changes in required documentation, program additions, and changes in policy and procedure

Sedentary position

Ability to work effectively with professional staff, and Hospital staff members

Ability to exercise good judgment in determining the correct course of action in admission procedures and to utilize independent thinking

Ability to maintain a cooperative, tactful, warm, courteous, and helpful attitude toward, professional staff, and Hospital personnel at all times

Dependability, flexibility, and efficiency, possessing a positive attitude toward work at Rogers Behavioral Health

Computer skills required, including navigating multiple monitors, payer portals, EHR systems (Cerner preferred), Microsoft Office (Outlook, Word, Excel), and real-time documentation tools

High accuracy and attention to detail in data entry, documentation, and interpreting patient financial responsibility (deductibles, copays, coinsurance)

Strong communication and problem-solving skills, including professional phone etiquette with payers, clear written documentation, time-management, and critical thinking

Commitment to confidentiality and HIPAA compliance while handling sensitive patient and insurance information

Verbal and hearing ability to interact with third-party payors and employees

Numerical ability to maintain records and operate a computer

Ability to read and communicate through written, verbal and auditory skills

Physical and mental ability to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical