Sr Insurance Verifier

FLSA STATUS

Non-exempt

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

• Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting

Required

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Proficiency in Microsoft office components (e.g., Outlook, Word) and knowledge of electronic health record software (EPIC preferred)
• Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies
• Ability to manage multiple tasks at one time
• Understands medical terminology at a high level and has knowledge of insurance requirements for physician visits and procedures
• Ability to manage a fast-paced environment
• Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume
• Ability to review clinical documentation for Medical Necessity and payer requirements
• Working knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred

• Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one another achieve optimal department results.
• Supports Insurance Verifiers with questions regarding pending authorizations and eligibility/benefit information for patients receiving services. Assists other team members (e.g., registration, financial counseling) as directed by management. Seeks management assistance appropriately.
• Contributes to patient, employee, and physician satisfaction. Proactively presents solutions to resolve access to care issues when possible. Serves as a liaison between the patients, facility, physicians, and department to ensure timely and accurate financial clearance of all accounts. Communicates with scheduling to inform patient of authorization as needed.
• Trains and mentors new team members.

• Ensures accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information. Assists with resolving electronic health record (EHR) work queues that support insurance verification. Generates reports and assists with department correspondence as directed.
• Initiates authorization for services as needed utilizing clinical information provided by the ordering physician. Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates.
• Communicates to resolve complex patient access and quality service matters. Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution. Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers. Maintains confidentiality in all communications.

• Timely and accurately obtains and records eligibility and benefit information, including limitations and exclusions, for all patients in the appropriate system(s) and screen(s)/field(s) within the system(s).
• Refers to the Health Care System’s financial clearance policy as a guideline and documents the appropriate patient liability portion – co-pays and/or deductibles – prior to, or on, the day of service.
• Provides expert level analysis of accounts and completes…