Insurance Verification Specialist (M-F 4:45am-1:30pm)

General Summary of Position

Department: Surgery Center

Status: Full-time, 40-hours per week

Schedule: Monday-Friday, 4:45am-1:30pm

Responsible for inpatient and outpatient registration activities, which include assessing the patient's financial status, identifying and obtaining a source of payment and gathering sufficient information to facilitate reimbursement, ensuring the notification is accurate and complete, and interfacing with insurers and members of the health care team. Requires proficient and professional encounters with other departments, insurance companies, third-party administrators, physician offices, and associates to input correct patient demographics and insurance information, verify eligibility, and identify and obtain referral and authorization needs to ensure a seamless revenue cycle process.

Primary Duties And Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Initiates and receives phone calls from patients (some transferred from clinical Departments) aimed at accurately completing insurance FSC/Plan information at the patient registration and visit levels of the billing system, including Alternate Insurance information on the Appointment Data Form if appropriate. Must have knowledge of MGUH insurance contracts and the associated rules for claim submission in order to perform successfully, which is defined as meeting or exceeding the published productivity standards regarding calls taken and/or placed, system edits resolved, and other quantifiable variables required.Tracks and maintains referral and preauthorization records for all patients and ensures that authorizations are obtained, updated, and recorded in a timely manner, such that patient care is not inappropriately delayed and that denials are minimized.Provides complete pre-authorization, insurance verification, and basic benefits information on all outpatient registration accounts for patients utilizing the Medical Center's clinical systems. Performs duties pertaining to registration to include the use of GE Centricity Business/IDX and its supporting eligibility software programs to ensure accurate registration and capture of authorization/referral information for both IDX and SMS Invision. Updates patient demographic and insurance information; Maintains Department standards in terms of accounts accessed & accuracy rates.Ensures the presence of pre-authorization and/or insurance referral numbers prior to a patient receiving services at GUH based on various insurance requirements & rules. Also assists with the tracking of continuing or multi-use authorizations and referrals, while staying in contact with appropriate clinical department staff members if difficulties arise.Provides benefit coordination for patients in order to properly instruct when services will or will not be covered by insurance and whether any co-payments or deductibles will be due at the point of service. Refers some cases to the proper department for Financial Assistance assessment prior to treatment.Corrects accounts that have erroneous registration information and ensures that all associated claims have the correct financial classification so that timely and accurate claim submission occurs, thus facilitating successful revenue cycle processes.Communicates effectively and maintains positive relationships with external audiences, this includes but is not limited to communicating directly with patients for clarification and follow-up purposes.Acts timely on system edits to ensure that proper actions are taken on accounts so that successful reimbursement for services will occur (IDX Alerts and SMS, for example)Documents accurate information in the Patient Accounting system to be utilized by all staff including PUBS, PFS, CBO, Case Management and Utilization Review (UR)Collaborates with and coordinates the expertise of various clinical depts, UR, and other business departments in order to ensure reimbursement criteria have been met. Serves as a resource to support and assist these same departments with questions regarding registration, FSC/Plan assignment and referrals as needed.Communicates to PUBS and PFS leadership any system or procedural problem or inconsistency to prevent the problem's recurrence or improve existing processes and participate in educational and professional development activities.Performs other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered all-inclusive.

Minimum Qualifications

Education

- High School Diploma or GED required

- Associate's degree preferred

- "CONSIDERATION WILL BE GIVEN TO AN APPROPRIATE COMBINATION OF EDUCATION/TRAINING AND EXPERIENCE"

Experience

- Experience in a customer service-oriented environment required and

- Experience in hospital or physician registration, insurance verification and/or medical billing required

Licenses and Certifications

- N/A

Knowledge, Skills, And Abilities

- Excellent oral and written communication skills, excellent customer service skills, Detail oriented. Excellent organizational skills.

- Proficiency with medical terminology, experience with basic anatomy/physiology.

- Understanding of medical terminology, ICD-9 codes, and third-party payer procedures.

- Knowledge of computerized registration, scheduling, and billing systems is a plus.

- Good interpersonal and communication skills.

This position has a hiring range of $18.33 - $31.61