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Cape Cod Healthcare · 2 hours ago

Jr Insurance Benefits Analyst

Massachusetts-Hyannis

Full-time

Onsite

Entry Level

1+ years exp

Cape Cod Healthcare is seeking a Jr Insurance Benefits Analyst to support the management team in improving processes related to insurance eligibility and patient registration. The role involves troubleshooting staff work, ensuring effective communication across departments, and maintaining compliance with regulatory requirements.

Health Care

Responsibilities

Troubleshoot and evaluate work product of staff, make recommendations to management and assists with implementing changes

Participate with management in strategizing for Process Improvement initiatives to improve cash flow

Attend and participate in management meetings

Assists management on special organizational projects for CCHC

Provide input and feedback for employee evaluations

Work collaboratively with Patient Access Managers, Scheduling Managers, Business Office Managers, Vendors and Customers across the enterprise to ensure that Registrars and Schedulers are fully capable of using technology to properly register our patients

Assists with review of financial clearance and registration procedures and ensure effective communication with physician practices, patients and internal departments

Work with department managers to continuously identify and correct issues identified by reporting

Assist Patient Access Managers with Quality Control assessments of their staff related to eligibility and pre-registration errors

Verifying insurance eligibility using available technologies, payer websites, or by phone contact with third party payers. Working in accordance with required State and Federal regulations and CCHC policies

Contact patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary

Ensure correct insurance company name, address, plan, and filing order are recorded in the patient accounting system

Processes outgoing referrals to specialists outlined by the patient’s insurance plans in a timely manner

Utilize payer websites and/or Epic/Experian to process, obtain and verify insurance referrals

Utilizing the incoming referral work queue will request, obtain and link insurance referral authorizations to upcoming specialty appointments as outlined by the patient’s insurance plan in a timely manner

Track, document and communicate the status of referrals as they move through the referral process, ensuring proper follow-up, documentation and communication when the referral has been completed

Maintain core competency and current knowledge of regulatory payer authorization and eligibility requirements

Obtain and verify authorizations to ensure payment for services provide through CCHC

Work accounts in assigned work queues to resolve billing errors and edits to ensure all claims are filed in a timely manner

Follow-up and work registration/authorization claim denial work queues to identify and take the appropriate action to fix errors for claim resubmission to payers

Maintain close coordination with Practice Managers, Clinical/Front End staff, and Physicians to advise of any changes or updates to insurance payer requirements

Responds to all practice inquiries and questions about insurances, referrals, and authorizations

Meets and maintains daily productivity and quality standards established in departmental policies

Assists the department, work unit and/or fellow staff members by cross-covering for absences, participating in special projects, and attending ongoing training sessions, etc

Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines

Ability to work with minimum supervision and in a team environment

Performs other job-related duties and assignments as requested/directed

Demonstrates the ability to adjust to unexpected changes to assure all responsibilities/duties are met during absences or increases in work volume

Qualification

EpicRevenue Cycle ManagementMedical TerminologyInsurance Payer WebsitesPC SkillsInterpersonal SkillsProblem SolvingCritical ThinkingVerbal CommunicationWritten Communication

Required

High School diploma or GED required

Minimum of one (1) year experience in a large hospital's Revenue Cycle Department with an emphasis on Patient Access and or Scheduling is strongly desired

Excellent interpersonal, problem solving and critical thinking skills

Excellent PC skills with a strong emphasis on the Outlook suite of products

Excellent verbal and written communication skills are required