Insurance Specialist I (Full Time) New Center One

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 inpatient admission at HFH.

Accountable and responsible for all pre-admissions, admissions, and discharges rendered at HFH.

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, deductible, and co-insurance information.

Resolves problem accounts to determine primary insurance and/or COB information.

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

Research and review all insurance plans and confirms patient benefit eligibility, including patient liabilities, clauses, riders, and secondary payor information (coordination of benefits).

Applies for insurance assignment for the uninsured motorist through the assigned claims facility in Lansing.

Acts as liaison between the patient and/or family members 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 interprets insurance group pre-certification requirements.

Ensures proper pre-authorizations have been obtained.

Executes on-line operations for specific payors to complete the pre-certification process.

Communicates data to HFH Utilization Management Department for further inpatient medical review.

Provides information to the appropriate billing specialist to ensure accurate bill

Secures documentation of insurance liability via internal and external resources, including DENIS, MPAC, HART, UGS, Medifax, HMOM, and the Internet. Resolves discrepancies by contacting patients, family members, and employers. Also contacts Medicare MSP department (secondary payor), Medicaid P.A.C.R. requirements area, Utilization Management, Medicaid and employer group HMO’s, Workmen’s Compensation, Blue Cross pre-certification area for updates for authorization screens, HAP membership, billing areas, and all other external agencies and patient advocates.

Determines the extent of liability for insurance plans, coordination of benefits and personal responsibility.

During the first year the training process for COB will begin. This will lead to reviewing and analyzing discrepancies and other related issues to ensure the integrity of the insurance information is accurate prior to discharge.

Identifies Qualified Medicare Beneficiaries (QMB) and interacts with Medical Services Administration (MSA). Medicare buy-in unit secures reimbursement. Also interacts with the Medicaid Exception Unit and the Third Party Liability Unit to amend discrepancies prior to billing. Involves contact with patients, SSA, MSA representative and outside contracted agencies to resolve problem accounts.

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

Identifies billing documentation requirements. Requests and coordinates document reports from appropriate resource areas, including but not limited to medical records, physician offices, and utilization review.

Prepare and ensures account for accuracy in preparation for billing to third party payors utilizing several different arenas within HFH computer system as well as other on line systems. Once secure releases account for billing.

Obtains referral from Primary Care Physician prior to admission for HMO insurance’s.

Maintains status on a daily, weekly, and monthly basis of all accounts pending verification reviews, utilizing OnTrac work lists, and takes appropriate action to resolve accounts.

Represents HFH to external agencies on issues involving admissions, financial policies and procedures.

Review and analyze Blue Cross third party COB screen prior to billing to prevent claims rejection. Works with patient or family member regarding outstanding COB issues by utilizing a BCBS form. Informs BCBS of information obtained.

Performs functions necessary to secure account on pre-admissions maintaining a lead-time of 7 – 10 days prior to admission.

Responsible for referring accounts to the Medicaid Liaison when an insurance cannot otherwise be secured.

EDUCATION AND EXPERIENCE:

High School Diploma or G.E.D. equivalent. College coursework in accounting, business, computers or health care administration is preferred.

One year of experience related to healthcare insurance eligibility, insurance verification or insurance billing in a hospital setting.

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

Excel and word processing experience desirable.

WORKING CONDITIONS:

Works in a fast paced environment.

Extensive utilization of personal computers.

Extensive telephone, oral and written contact with internal and external customers.

Overview
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health

care systems, is a national leader in clinical care, research and education. The system includes

the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health

insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory

network and many other health-related entities throughout southeast Michigan, providing a

full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.

The health system also is a major economic driver in Michigan and employs more than 24,600

employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The

health system is led by President and CEO Wright Lassiter III. To learn more, visit HenryFord.com .

Benefits
Whether it’s offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it’s all about choice. Henry

Ford Health System has a new approach for its employee benefits program – My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning – options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

benefits and services.

Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System 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.