Insurance Specialist (HHC) - 40 hours/Week - Days

Henry Ford Health System • Detroit, MI • 2h ago

GENERAL SUMMARY:

Under general supervision, identifies and determines in accordance with established policies and procedures the accuracy and completeness of financial, insurance and/or demographic information for patients receiving care HFHS. Accountable and responsible for all pre-admissions, admissions, and specified scheduled outpatient services rendered at HFHS. Investigates and reviews the accuracy and completeness of insurance information upon pre-admission and/or admission to ensure account is secure prior to discharge. Obtains benefit, co-pay, deductible, and co-insurance information. Verifies insurance eligibility and benefit information and confirms that all insurance requirements are met, including but not limited to referrals and authorizations. Resolves problem accounts to determine primary insurance and/or COB information.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

A variety of functions and responsibilities related to insurance verification and identifying authorization requirements prior to and/or after discharge of patient, which includes:

Research and review all insurance plans and confirm patient benefit eligibility, including patient liabilities, clauses, riders, and secondary payor information (coordination of benefits) via internal and external resources including contacting payor representatives as needed.

Reviews and interprets insurance group pre-certification requirements. Ensure proper pre-authorizations have been obtained. Execute on-line operations for specific payors to complete the pre-certification process. Communicate data to HFHS Utilization Management Department for further medical review.

Resolves discrepancies with the patient and/or family members, employers and insurance companies to assist in obtaining insurance information. Interviews patients and/or family members; advises patient with regards to next steps or processes for securing financial coverage. Reviews and analyzes third party COB screen prior to billing to prevent claims rejection. Works with patients or family member regarding outstanding COB issues.

Reviews, analyzes and corrects COB discrepancies and other related issues to ensure the integrity of the insurance information is accurate prior to discharge.

Handles insurance questions and/or obtains information from various HFHS areas including but not limited to clinics, physicians, patients, attorneys, employers and outside agencies via telephone or mail.

EDUCATION/EXPERIENCE REQUIRED:

High school diploma or GED equivalent is required.

Two (2) years of experience related to healthcare insurance eligibility, insurance verification or insurance billing in a hospital/medical office setting.

Knowledge of various insurance coverage, COB rules of priority and processing procedures.

Insurance payor systems experience required.

EPIC training/experience preferred.

ICD-10 medical terminology experience preferred.

Additional Information

Organization: Community Care Services

Department: HHC Intake

Shift: Day Job

Union Code: Not Applicable

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services - from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.

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