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*Description*

At Nuvance Health, we enjoy the benefits of a two-state system as we cultivate an inclusive culture where everyone feels welcomed, respected and supported. Together, we are a team of 15,000+ strong hearts and open minds. If you share our values of connected, personal, agile and imaginative, we invite you to discover what’s possible for you and your career.

Northern Dutchess Hospital is an 84-bed hospital located in picturesque Rhinebeck, New York. We are leaders in the Hudson Valley for maternity and orthopedic excellence and provide award-winning care in a wide range of specialties, from cancer and heart disease prevention to bariatric surgery and healthy aging services.

Our accolades include the following:

* The Leapfrog Group - Grade A for quality and patient safety

* U.S. News & World Report - High performance in knee replacement

* Surgical Review Corporation (SRC) - Robotic Center of Excellence

* Center for Medicare and Medicaid Services (CMS) - 5 Star Rating

At Northern Dutchess Hospital, we pride ourselves on a culture of collaboration and teamwork, where every voice is valued and contributes to our shared success. When you step through our doors, you will feel a warm and welcoming atmosphere that makes our hospital a truly special place to work. Our staff is friendly, dedicated and deeply committed to the well-being of our patients and each other’s success.

*Summary:*

* The Insurance Reimbursement Specialist is responsible for coordination and support of initiatives relative to the evaluation, processing, and handling of insurance verification/authorizations and patient benefits. Acts as a liaison between the insurance providers and agents, claimants, and policy holders regarding the status and eligibility for coverage for rehab services. This role is also an experienced back up to all other outpatient rehab support functions to include patient appointment scheduling, coverage of front desk, answering phones, checking in patients, and collecting co-pays.

*Responsibilities*:

* Performs insurance eligibility verification/authorization and executes payor requirements as needed. Includes initiating eligibility transactions to obtain necessary billing information and authorization, referrals for service when appropriate.

* Obtains and understands necessary clinical information (including diagnoses) to initiate requests for authorizations.

* Ensures that proper selection of insurance, plan type, financial obligations, pre-certification and billing address are assigned in the system.

* Communicates and updates all information in medical record pertaining to patient’s financial obligations to individual therapy sites, clinicians and billing office to ensure all therapy treatments are authorized. This includes but not limited to copayments, deductibles, self-pay rates, in-and-out of network responsibilities, referrals, authorizations and other information as needed.

* Answers patient inquiries regarding their liability and able to explain variables involved and assists in mitigating any issues or barriers that may come up. Determines need for financial counseling and directs patient to appropriate Nuvance Health resources.

* Collaborates with business office, clinical teams and patient for the denial and appeals process, as necessary.

* Maintains communication with System departments (e.g., managed care, SBO, FCC) to identify any changes, trends, or updates to existing or new contracts the System may have with an insurance company.

* Serves as back-up to other administrative functions as needed to includeregistering patients, scheduling patients, managing front desk operations (answering phones, collecting co-pays, etc..) and tracking plans of care.

* Performs other duties as assigned

* Ability to travel between outpatient sites, as assigned, based on coverage needs.

*Job Qualifications:*

* Experience with medical terminology, medical coding, billing procedures, medical records.

* Basic knowledge of payor guidelines.

*Working Conditions*

* Working Conditions:

* Manual: significant manual skills/motor coord & finger dexterity

* Occupational: Little or no potential for occupational risk

* Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

* Physical Environment: Generally pleasant working conditions

* Company: Northern Dutchess Hospital

* Org Unit: 1876

* Department: Rehab Services Admin

* Exempt: No

* Salary Range: $19.54 - $37.94 Hourly

With strong hearts and open minds, we’re pushing past boundaries and challenging the expected, all in the name of possibility. We are neighbors caring for neighbors, working together as partners in health to improve the lives of the people we serve. If you share our passion for the health of our communities, advance your career with Nuvance Health!

We are an equal opportunity employer

Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.