New job PreArrival Management Specialist in South Dakota

JOB SUMMARY: PreArrival Management Specialist is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Financial Clearance Specialists must determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable.

Specialists must also be able to understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities in order to provide patients and families with information on their financial responsibility. The PreArrival Management Specialist will calculate and communicates to the patient a financial responsibility estimation, provide charity applications and/or direct the patient to the business office for payment and assistance options. Specialists will collect patient liability prior to service and attempt to collect prior balances.. The Specialist also collaborates with the Utilization Review, Business Office and the Patient Advocates to ensure proper reimbursement on accounts. Specialists are to conduct all transactions appropriately and consistently, and complete government regulatory forms accurately with the patient or patient’s representative. Specialists must maintain compliance with government regulations (i.e. EMTALA and HIPAA) as it pertains to the insurance process.

EDUCATION and/or EXPERIENCE:

• High school diploma or general education degree required.
• Associate’s Degree in finance, business or healthcare preferred.
• One to two years related experience in billing, insurance or registration required.
• Healthcare experience required.