The Insurance Specialist is responsible for working with a team and supporting management for behavioral health facility and professional charges. Individual is responsible for all revenue cycle processes including but not limited to financial securing, insurance verification, obtaining prior authorizations, claim follow up and denial management.
Acts as a liaison between patients, their health insurance, and clinics/providers to assist in understanding their healthcare financial responsibilities. Provides clinic staff with the correct insurance information to enable a streamlined check in process for the patient. Works to establish timely, correct payment information prior to the patients service to financially secure the account, promote good customer service, efficient and accurate billing, and prompt reimbursement. Advises patient/clinic on referral necessity. Advises self-pay patients of out of pocket expenses, insurance limitations and payment options prior to specific services to reduce the patients as well as the organizations financial risk.
Contacts and maintains relationships with the payer communities to obtain and verify insurance benefits and eligibility for behavioral health services upon receipt of intake forms or notification of scheduled visits using on-line remotes, eligibility system or by calling directly. Includes group number, billing address, type of contract, employer, co-pay, and subscriber information, etc.
At year-end confirms and verifies benefits for existing patients at the start of each new plan Year.
Serves as the liaison for all insurance questions regarding appropriate plan codes to use and how to correctly update a patients account and resubmission of claims.
Works to establish timely, correct payment information prior to the patients service to financially secure the account, promote good customer service, efficient and accurate billing, and prompt reimbursement.
Informs providers/schedulers of limited benefits and non-covered services.
Discusses benefits with patients 10-14 days in advance of appointment to explain the variation between medical and behavioral health benefits so the patient can make an informed decision as to whether to receive treatment.
Communication with providers and clinical staff daily to advise clinic staff of patients financial obligations co-pays to be collected and necessary waivers to sign upon arrival.
Requests documentation from providers to obtain prior authorization for services.
Introduces new providers to revenue cycle workflows and new initiatives prior to implementation.
Works payor correspondence.
Perform timely claim follow up to ensure reimbursement for services.
Effectively work insurance denials an appeal when necessary with knowledge of payor policies/guidelines.
High school diploma
Extensive knowledge of MNsure, MN Medicaid, boarder state Medicaid programs and replacement plans
Three or more years in insurance resolution, patient accounting or medical billing with exposure to medical terminology, financial securing, denials, and patient interaction
Behavioral/Mental Health clinical, insurance claims process or business office knowledge
Knowledge of professional and facility billing including reading payor remittances and payor websites
Bachelors degree in health care related major
Extensive knowledge of MNsure, MN Medicaid, boarder state Medicaid programs and replacement plans.
Five or more years in the insurance verification role in an ambulatory and acute setting
Experience working complex academic medical center or in a related patient financial services area, with strong medical terminology and medical billing knowledge
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.