The Insurance Reimbursement and Verification Specialist will oversee the insurance verification and all third party payer relationships.  This individual shall serve as the primary liaison with internal and external stakeholders, including but not limited to potential patients and individuals supported, their representatives, insurance companies, and others in the process of defining all funding sources, benefit coverages, COB, insurance ranking  and patient financial communications. 

1. Pre-certified applicants’ insurance plans for assurance of payment commitment from insurance carriers, in some cases
2. Assists in developing  procedures and guidelines pursuant to the insurance policy and/or contract for billing of services provided as needed.  
3. Collaborates with program representatives to determine eligibility for coverage for new and existing service and support recipients.
4. Works with internal health care administration and practitioners to process necessary referrals and ensure payment for eligible services from third party payers. 
5. Supports the resolution of issues at the earliest stage of the billing process, including resolution of rejected claims to ensure payment of all claims meeting eligibility requirements.
6. Performs financial communications  to all applicants’, service recipients’, and insurance representatives’ inquiries relating to insurance coverage for services, eligibility issues, patient share, balance resolution and other inquiries relating to coverages and services.
7. Identifies, researches, and resolves differences in payment versus expected payment from third party payers, if situations arise.
8. Able to evaluate, understand and explain an insurance explanation of benefits in an effort to support service recipient’s interpretation of coverage and potential financial exposure.   
9. Documents all insurance verification results in the applicable system for all funders related to the patient or individuals services being rendered.  
10. Maintains effective relationships and open communications with Bancroft staff, service recipients, visitors and community members.   
11. Performs other related duties, special assignments and projects, as required.  Remains flexible and adaptable in work schedule as defined by organizational needs. 
12. Abides by the Bancroft Code of Ethics, Mission Statement, and Vision Statement in promoting ethical behavior, establishing relationships and providing guidance in decision-making situations.
13. Remains current with required training certifications, meets state-regulated licensing and regulatory accreditations, and adheres to mandatory requirements.
14. Willingly and effectively cooperates with Bancroft, The Department of Human Services, The Division of Developmental Disabilities (DDD), and other Pennsylvania and Delaware licensing or state agency or local municipalities in any inspections and investigations, upon request. 
15. Maintains a safe and respectful environment, free of abuse, neglect, or exploitation; does not allow weapons, threats, bullying or intimidation.
16. Reports any violations of Bancroft policy and procedure to the appropriate individual as soon as the incident occurs.
17. Demonstrates Bancroft’s core value of Respect in the performance of position responsibilities.

Education & Experience:

HS diploma, with a certificate or associate’s degree in Health Care Reimbursement preferred and demonstrated experience of at least three years in the medical reimbursement and verification process required.  Knowledge of CPT, HCPCS coding, medical terminology and disability funders a plus.  The successful applicant will be proficient in Excel, and other Microsoft Applications, including Word and Outlook.

Special Skills:

• Customer service oriented with a focus on problem resolution and good outcomes for internal and external stakeholders
• Excellent interpersonal skills and demonstrated strength in written and verbal communications.
• Able to glean and retain information and record accurate notes.
• Able to follow procedures and be detailed oriented
• Able to collaborate and communicate effectively with all levels of the organization.
• High degree of integrity with a strong mission orientation, consistent with Bancroft’s vision, mission and values
• Valid driver’s license required in incumbent’s legal name and current address with no provisional restrictions.  Minimum 18 years of age required.

Bancroft stands strong against racism and hate of all kinds and supports actions leading to respect, equality, fairness and peace. We advocate for and embrace an inclusive and just world. One world. For everyone. We work with heart, respect and collaboration. We are communicators, listeners, problem solvers, partners and collaborators. Bring your authentic self to our team.