Specialist III - Insurance Specialist (Conroe, TX)
Sam Houston State University

Job Info

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Requisition:

202400320S

Title:

Specialist III - Insurance Specialist (Conroe, TX)

FLSA status:

Non-Exempt

Hiring Salary:

This position is a pay grade 6. Please see Pay Grade Table at: https://pa-hrsuite-production.s3.amazonaws.com/116/docs/636763.pdf

Occupational Category:

Technical/Para-Professional

Department:

COM Clinical Practice

Division:

Division of Academic Affairs

Open Date:

09/10/2024

Open Until Filled:

Yes

Educational and Experience Requirement:

Associates degree. Bachelor's degree preferred. Three years of experience in Healthcare Credentialing/HIMs/Referrals. Additional experience may be considered in lieu of education.

Nature & Purpose of Position:

Performs specialist duties for Credentialing/HIMs and Referrals.

Primary Responsibilities:

Credentialing/BillingStarts and finishes credentialing process during onboarding. Creates and maintains licensing, credentials, and insurance records. Conducts research on updated state and federal regulations and policies. Releases information to requesting agencies and public inquiries when required by law. Helps develop internal credentialing processes. Monitors license and credential expiration dates and advise staff members of required "renew by" dates. Ensures the facility and staff members are maintaining compliance with regulatory and accrediting institutions. Knowledge of Medical Billing

Referrals/HIMsMaintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an IT database. Ensures complete and accurate registration, including patient demographic and current insurance information. Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist. Contacts review organizations and insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians. Reviews details and expectations about the referral with patients. Assists patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance). System navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion. Identifies and utilize cultural and community resources. Establishes and maintains relationships with identified service providers. Ensures that referrals are addressed in a timely manner. Reminds patients of scheduled appointments via mail or phone. Ensures HIMs are processed and received. Performs additional related duties as required.

Other Specifications:

Must have experience with CAQH, Availity, TMHP, CMS, PECOS, And Insurance Carrier Portals. Requires a high level of organization and self-management. Will need to demonstrate exceptional customer service in all interactions with internal and external customers. Strong problem-solving abilities are needed for success. Must be a strong multi-tasker with attention to detail.

This position will be required to maintain patient and staff confidentiality in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA) regulations.

This position is located at the Physician Clinic for the College of Osteopathic Medicine in Conroe, Texas.

Up to 20% of this position, over the fiscal year during off-peak periods, may be performed remotely as determined by the supervisor.

Full Time Part Time:

Full Time

Quicklink:

https://shsu.peopleadmin.com/postings/40873

EEO Statement:

Sam Houston State University is an Equal Employment Opportunity/Affirmative Action Employer and Smoke/Drug-Free Workplace. All qualified applicants will receive consideration for employment without regard to race, creed, ancestry, marital status, citizenship, color, religion, sex, national origin, age, veteran status, disability status, sexual orientation, pregnancy, or gender identity or expression. Sam Houston State University is an "at will" employer. Employees with a contract will have additional terms and conditions. Security sensitive positions at SHSU require background checks in accordance with Education Code § 51.215.

Annual Security and Fire Safety Report

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