UnityPoint Health Insurance Coordinator-Outpatient Therapy in Cedar Rapids, Iowa
Description of Position:
Provide a “snapshot” or the principal purpose or focus of the position, consisting of no more than three to five sentences. This summary should provide enough information to differentiate the major function and activities of the position from those of other positions.
The Insurance Coordinator is responsible for complex insurance eligibility and benefits verification as well as complex denial work queues within Therapy Plus, Witwer Children’s Therapy, Hospital Outpatient Therapy, PMR physician clinic and other PMR department(s) as needed. Also oversees and assists the PMR physician clinic with insurance benefit verification and pre-authorizations for procedures. The Insurance Coordinator is a resource for the Business Operations Manager, lead scheduling/financial specialists, therapy managers, scheduler/financial specialist, therapists and Witwer Children’s Therapy case manager regarding all aspects of patient insurance.
Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
· Verifies complex patient insurance eligibility and coverage via phone or internet. Documents in account notes in EPIC.
· Resource/assist in the PMR division for complex pre-authorizations, including therapy, Botox, prescriptions, and Neuropsych testing. Obtain all necessary pre-authorizations for PMR Clinic procedures.
· Researches and maintains database of changes to Medicare (CCI edits and local payer coding), Medicaid, commercial and worker’s compensation insurance billing regulations for all departments and CPT codes billed.
· Responds to patients’ questions regarding their account and assists in finding solutions to billing concerns.
· Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.
· Problem solves, analyzes and collaborates with patient, therapist, physician providers, case managers, Central Billing Office, Revenue Cycle department, and insurance companies to identify and resolve billing and denial issues, including sending appeals and trouble-shooting and correcting claim or account errors.
· Identifies denial and billing processes that need improvement to maximize efficiency and ensure proper payment within the division.
· Reconciles daily patient attendance and charges posted with revenue/usage reports and chart audits for PMR Clinic.
· Performs additional chart and charge audits as needed.
· Establishes and maintains accurate files using word processing and spreadsheet documents.
· Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information related to billing/insurance/denials.
Basic UPH Performance Criteria
· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
· Demonstrates ability to meet business needs of department with regular, reliable attendance.
· Employee maintains current licenses and/or certifications required for the position.
· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
· Completes all annual education and competency requirements within the calendar year.
· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
· Leverage the skills and abilities of each person to enable great teams.
· Collaborate across departments, facilities, business units and regions.
· Seek to understand and are open to diverse thoughts and perspectives.
Own The Moment:
· Connect with each person treating them with courtesy, compassion, empathy and respect
· Enthusiastically engage in our work.
· Accountable for our individual actions and our team performance.
· Responsible for solving problems regardless of the origin.
· Commit to the best outcomes and highest quality.
· Have a relentless focus on exceeding expectations.
· Believe in sharing our results, learning from our mistakes and celebrating our successes.
· Embrace and promote innovation and transformation.
· Create partnerships that improve care delivery in our communities.
· Have the courage to challenge the status quo.
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
Associate’s degree required, or an equivalent combination of education and experience
Bachelor’s degree preferred
Extensive knowledge of Medicare (CCI edits and local payer coding), Medicaid, commercial and worker’s compensation insurance billing regulations
Prior secretarial experience in a medical environment preferred
Valid driver’s license when driving any vehicle for work-related reasons.
Writes, reads, comprehends and speaks fluent English
Microsoft Office and Outlook – basic computer skills
Critical thinking skills using independent judgment in making decisions
High organizational skills
Ability to multi-task
High attention to detail
Experience with medical insurance processing
Medical terminology and ICD-10 coding
Ability to articulate insurance information as it relates to patient understanding and any action needed
Use of usual and customary equipment used to perform essential functions of the position.
Work may occasionally require travel to other UPH facilities. May drive a UPH vehicle, rental or own vehicle.
Requisition ID: 2020-75635
Street: 1026 A Ave NE
Name: 1010 UnityPoint Health CR St Lukes Hospital
Name: Rehab Administration
FLSA Status: Non-Exempt
Scheduled Hours/Shift: Full Time, First Shift
External Company URL: http://www.unitypoint.org