Position Summary:

Under the direction of the Business Office Manager, Responsible for the timely pre-certification, authorization, and verification of insurance coverage for pre-admissions, admissions, and specified procedures. The insurance verification specialist will obtain accurate patient demographic and financial information to assist in the patient registration upon arrival. This professional also serves as a valuable resource to patients, providing them with pertinent information regarding their insurance coverage; and works with patients to explain coverage amounts provided by their insurance policy. The insurance verification specialist also helps patients arrange payment for services that are not covered by their insurance companies inclusive of different financing options as defined by policy.

Essential Job Functions

Perform pre-registration and insurance verification within 72 hours of receipt of reservation/notification for both inpatient and outpatient services

Print procedure schedules daily

Follow –up on schedules daily for patient add ons

Follow scripted benefits verification and pre-certification format

Contact physician offices to resolve issues regarding prior authorization or referral forms

Assign insurance mnemonics accurately

Perform electronic eligibility confirmation when applicable and document results

Research patient visit history to ensure compliance with payer specific payment window rules

Calculate patient cost and be prepared to collect via phone or make payment arrangement

Contact patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment

Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues

Meets/exceeds performance expectations and completes work within the required time frames

Implements and follows system downtime procedures when necessary

Scan documents into the patient accounting system

Other duties as assigned

Qualifications/Requirements

High school diploma, Post-secondary education preferred

2 years related experience and/or training

Operational knowledge of computers

Strong written & verbal communication skills

Strong telephone etiquette

Works successfully in a cross-functional team environment

Practical problem solving skills

Dependable attendance

Able to work independently with minimal direct supervision

Able to prioritize multiple tasks

Strong organizational skills

Physical Abilities

Reaching, bending, stooping & stretching

Able to lift 10 pounds from ground level without assistance

Visual acuity