Summary:

Candidates must live within driving distance of Oconomowoc, WI .

The Benefit Verification Specialist I plays a key role in ensuring that front-end teams coordinating patient care have a clear understanding of each patient’s behavioral health insurance benefits prior to treatment. As the first step in the patient’s financial experience, this position verifies behavioral health benefits, determines patient financial responsibility, and communicates coverage information effectively to internal teams to support timely and accurate admissions and claims. The specialist is also responsible for identifying and correcting demographic errors daily, ensuring accuracy and compliance for all admitted patients.

Job Duties & Responsibilities:

Verify behavioral health insurance benefits for patients and potential patients

• Spend significant time on the phone and online with insurance and managed care companies to confirm behavioral health coverage, limitations, referrals and authorization requirements.  

• Use online payer portals as well as facility resources, managed care grids to accurately receive, interpret, and document benefit information.as required

• Accurately document quote of benefit details in Cerner, using correct dropdown selections, updating required fields, and assigning items to follow-up worklists as appropriate

Maintain high-level multitasking by actively working in multiple systems at once, verifying benefits, completing portal checks, correcting registration or demographic errors, and documenting results in Cerner, all while navigating multiple monitors and continuing productive work during insurance hold times. Audit demographic, insurance and financial data daily to ensure accuracy for encounters.

• Communicate with admissions, care coordination and utilization review teams to ensure accuracy of accounts Identify potential coverage issues and escalate appropriately to avoid admission delays.

• Knowledge of Rogers programs and the facility’s admission, insurance authorization, and billing processes.

Support departmental goals and team development

• Participate in daily peer audits and huddles, providing and receiving constructive feedback in a professional manner.

• Maintain up-to-date knowledge of behavioral health payer policies, authorization requirements, and facility programs.

• Support patients and internal teams by addressing benefit-related questions promptly and accurately.

• Contribute to training efforts, uphold department policies and procedures, and demonstrate punctuality, professionalism, and teamwork.

Apply good practice principles to job duties.

• Use good communication skills and tact to deal effectively with third-party carrier representatives, and all other team members internally and externally.

• Use common sense in situations and respond appropriately in all communication modes (body language, verbal) to everyone, regardless of his/her/their behavior.

• Maintain a calm attitude and create a conducive atmosphere in difficult situations.

• Work cooperatively and supportively with all

• Remain courteous and respectful to others during work interactions and be willing to work out problems on a one-on-one basis.

• Complete assignments and documentation on time.

• Take responsibility for and manage day-to-day problems, including completion of all documents.

Complete other duties as assigned by the supervisor of Benefit Verification team

Promote department goals and the Mission of Rogers Behavioral Health.

• Communicate goals to fellow staff members.

• Demonstrate measurable goal achievement.

• Maintain department policies and procedures.

• Include requirements and guidelines from external agencies (State of Wisconsin, Joint Commission).

Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.

• Demonstrate acceptance and training of student interns in the department, as directed.

Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations.

• Involve self in the learning and application of standards relevant to Admission Services.

Participate in i