Healthcare Insurance Specialist - Revenue Cycle Management - Robert S. Smith, M.D., Inc.

Company Summary:

VIZIA Diagnostics is a stand-alone, surgical pathology laboratory serving clients nationwide. Our team is focused on delivering best-in-class service excellence in diagnostic patient care. 

We are a subspecialty model dedicated to the practice of gastrointestinal pathology with GI subspecialty-trained and experienced pathologists and histotechnicians focused exclusively on GI specimens to ensure the highest level of quality. VIZIA is a growing company with potential advancement into other surgical pathology specialties, including a more robust genitourinary practice.

In 2023, VIZIA was formed through an acquisition from Boston Scientific Corporation. With more than 30 years of operational expertise and advancements in diagnostic services, we are proud of what we have accomplished, but we are even more excited about what we will achieve together.

Position Summary:

The Insurance Specialist accurately inputs the patient's health insurance information into the Laboratory Information System in a comprehensive insurance report format. The Specialist diligently seeks erroneous or inconsistent information, then verifying and correcting the inaccurate information.  The insurance specialist utilizes Availity to obtain missing insurance information and verify information submitted by the client, when needed. 

Specific Responsibilities:

1. Accurately input patient's primary and secondary insurance plan data into LIS.
2. Utilize the requisition and/or face sheets from the client to obtain information needed.
3. Locate and verify information in Availity for accuracy of input.
4. Reports and escalates trends, as identified.
5. Serves as a resource for insurance plan expertise.
6. Work closely with the Data Entry team and Leadership to ensure department deadlines are met.
7. Assist with insurance orientation, and training when needed.
8. Prepare daily quality and performance reports.
9. Foster cross functional relationships to achieve departmental goals.
10. Understands and performs basic quality control, working with Quality to identify quality control problems and participate in quality continuous improvements.
11. Performs other duties as assigned.

VIZIA Diagnostics Pathology Laboratory attests to the following: For HIPAA compliance purposes, this position has been reviewed by management and meets the 'need to know' PHI access criteria of the HIPAA Security Rule. Additionally, per the HIPAA Privacy Rule, the minimum necessary PHI data elements have been identified by management and the minimum necessary PHI access has been granted to the employee/contractor for them to satisfactorily execute the role and responsibilities of this position.

Qualifications & Experience:

• High School Graduate or General Education Degree (GED)
• 5 years of experience in a health care environment
• 4 years of experience in medical billing with an emphasis on insurance eligibility and verifications or authorizations.
• Accounts receivable knowledge a plus
• Demonstrated knowledge of computer systems and design

Summary:

Quality System Requirements:

In all actions, demonstrates a primary commitment to patient safety and product quality by maintaining compliance with the Quality Policy and all other documented quality processes and procedures.

For those individuals that supervise others, the following statements are applicable:

• Assures that appropriate resources (personnel, tools, etc.) are maintained to assure Quality System compliance and adherence to the VIZIA Diagnostics Quality Policy.
• Establishes and promotes a work environment that supports the Quality Policy and Quality System.

Knowledge:

Complete knowledge of the job.  Knowledge of insurance and ability to distinguish different plan products. Applies thorough knowledge of business concepts, procedures and practices, and a complete understanding of fundamentals in the functional area and working knowledge of other related disciplines. In-depth expertise in company's core hardware and software package (i.e., working with multiple worksheets in Excel; producing advanced screen shows in PowerPoint; inserting graphics, charts, and tables in Word; creating forms).

Cognitive Skills:

Performs mostly non-routine assignments requiring basic interpretation of established procedures. Applies strong business writing, proofreading, and editing skills (i.e., independently generates correspondence with only brief content outline from supervisor) when completing work.

Job Skills:

Detail-oriented and ability to maintain a high-level of accuracy in keying operations. Answers functional questions from internal customers; viewed as a key functional resource for insurance inquiry. Performs general administrative duties and able to create letters, memos, reports, and presentations.   Anticipates and coordinates assignments and organizes own schedule to meet deadlines.

Supervision Received:

Works under general supervision with general instructions given on new assignments.

Consequence of Errors:

Errors are costly and lead to ineffectiveness in our processes and normally result in high expenditures to resolve.

Time Commitment:

The role is a full-time hybrid responsibility.