Medical Insurance Specialist – Direct Hire, Lemoyne, PA

Job title:

Medical Insurance Specialist – Direct Hire, Lemoyne, PA

Company

Novus Group

Job description

Novus Group is your advocate to DIRECT HIRE positions with a multibillion-dollar organization. We partner with the employer to help you make any resume revisions, interview preparation, and compensation negotiation to get your foot in the door. We meet with the employer to get feedback on your resume, your interviews, and all facets of your candidacy…ALL AT NO COST TO YOU! The Company pays our fees to help develop talent all the way through the employment lifecycle up to and including the offer of employment.Employees of this organization can enjoy the following benefits and much more!

• Caregiving support for childcare/elderly family members

• Paid time off up to 5 weeks

• Student Loan Refinancing / forgiveness

• Medical, Dental, Vision and other coverages

• Up to 8% retirement savings match

• Up to $6,000 per year in Tuition Assistance to you and your immediate family

• Adoption Assistance, Pet Insurance and Retail Perks & Discounts

• Ongoing learning

• Accelerated Career Path

• Flexible work arrangements

• 7 holidays per year

• PTO buy back and selling excess, when eligible

Medical Insurance Specialist – Lemoyne, PA 17043 (Camp Hill/Lemoyne Area)

• Full-time hire as an employee of the Company with full access to benefits
• Monday – Friday – Daylight – 8:30 a.m. – 5:00 p.m.
• $19.00 – $23.00 per hour as new employee (performance raises available, after hire)
• After hire, additional performance-based increases in compensation can be earned up to $28 per hour

Successful candidates will have: minimum of HS Diploma or equivalent (required), Minimum 1+ years of experience in physician’s office or outpatient office (required) with a focus on insurance guidelines, authorizations and referral processes, knowledge of medical terminology, anatomy, disease processes, CPT and ICD-9 coding, and managed care. Strong computer skills, (Windows, Word, Excel and Outlook), strong organization and communication skills able to work in team environment.Must have at minimum all of the following:

• High School Diploma or equivalent
• Minimum 1+ years’ work experience in physician’s office or outpatient facility – REQUIRED
• Microsoft Office Suite proficiency required
• Proficiency with word processing, e-mail, Outlook calendar functions, Excel Spreadsheets, PowerPoint Presentations, and database software
• Knowledge of insurance companies, guidelines and requirements, authorization and referral process and websites.
• Knowledge of medical terminology, anatomy, disease processes, CPT and ICD-9 coding, and managed care policies and procedures.
• Must possess strong organization and communication skills and be able to work independently and within a team.
• Experience with obtaining insurance authorizations
• Health insurance verification experience
• Proficient level of knowledge and experience with medical terminology
• Experience with health records system Medipac/EPIC software

Purpose of the Position:Responsible for coordination of the referral process within the outpatient sites. Responsible for coordinating specialty referrals and diagnostic testing for outpatient facilities. Pre-certifies diagnostic testing, as required by patients’ insurance. Educates the patients on various policies, procedures, and benefits, related to the need for referrals. Coordinates referrals with patients and specialist’s offices, and process insurance referrals as required. Acts as a liaison between patient, physician, and insurance company, consistently performing activities in a friendly, courteous, and professional manner. Responsible for processing referral/authorizations for greater than 3 specialties and multiple geographical locations.Responsibilities:

• Interacts with physicians, physician extenders, and all fellow employees in a courteous and professional manner.
• Clearly explaining all policies and procedures, answering questions, and providing instruction to patients and family members in an age specific manner.
• Being aware of the individual’s needs, receptive to questions and criticism, and willing to offer assistance.
• Protecting each person’s legal and moral right to confidentiality.
• Utilizes electronic referral and authorization services as available.
• Communicates with insurance offices to authorize services.
• Takes referral requests from patient, specialist, and primary care office.
• Answers telephone in a timely, pleasant, and professional manner.
• Handles appeal requests with insurance company when necessary.
• Coordinates out of network exceptions with insurance company when necessary.
• Provides necessary patient medical information to insurance upon request.
• Obtains authorizations with insurance companies for diagnostic testing.
• Accurately schedules appointment with attention to all scheduling criteria.
• Transcribes Epic orders as indicated by the ordering provider.
• Handles Urgent and ASAP appointment requests in a timely fashion.
• Maintains up-to-date listing of all network providers.
• Completes insurance referrals for patient’s scheduled appointments.
• Monitors referrals to ensure patients stay within network. If patient goes out of the network, coordinates with insurance to get patient back into network.
• Coordinates appointments for diagnostic testing. Advises patient of test prep if applicable. Obtains insurance for authorization, if applicable.
• Sends appointment request to specialist with appropriate patient records. Processes insurance referral if applicable.
• Coordinates appointments with specialist’s offices in and outside of the local area.
• Attends meetings and training sessions provided by insurers.
• Handles patient inquiries related to referrals and authorizations.
• Maintains up to date referral and authorization guidelines and requirements from insurance companies.
• Educates/assist providers on accurate diagnostic test order selection based on current radiology guidelines.
• Educates members, providers, and office staff on the insurance guidelines and requirements, related to the referral and authorization process.

Expected salary

$19.14 – 28.71 per hour

Location

Lemoyne, PA

Job date

Wed, 20 Nov 2024 23:07:36 GMT

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