Insurance Verification Coordinator

Job Family:
Admitting Representative
Travel Required:
None
Clearance Required:
None
What You Will Do:
The Insurance Verification Coordinator (IVC) manages the daily monitoring of the patient census to determine health plan benefits and requirements for newly admitted inpatient and observation patients. The IVC is responsible for health plan notification upon the admission of their members. In addition to notification requirements, the IVC shall also secure applicable authorizations, certifications and tracking numbers as outlined by payor guidelines.
Essential Functions and Responsibilities:

• Provides notification of admission to the patient's health plan in a timely manner as dictated by contractual agreements.
• Obtains tracking numbers, certifications and authorizations as required.
• Reviews all hospital admissions and maternity accounts to verify insurance eligibility and benefits.
• Documents patient benefits and patient financial responsibility in the patient registration system.
• Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital payment policy. Offers option of Financial Assistance and Charity to assist in acceptable resolution of estimated patient balance.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Community Memorial Healthcare Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected and upheld.
• Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including but not limited to HIPAA privacy and security regulations, DNV and the No Surprises Act (NSA) mandate.
• Ongoing written and verbal communication with case managers regarding authorization, re-authorization, and retro-authorization of visits.
• Ongoing written and verbal communication with case managers regarding authorization, re-authorization, and retro-authorization of visits
• Serves as preceptor/trainers to new hires and orienteers.
• Serves as a mentor to new hires and assists in new hire orientation.
• Acts as a resource and subject matter expert.
• Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel).
• Excellent communication and outstanding customer service and listening skills.
• Basic keyboarding skills.
• Ability to analyze and interpret data.
• Critical thinking, sound judgment and strong problem-solving skills essential.
• Team oriented, open minded, flexible, and willing to learn.
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral or written instructions and established procedures.
• Ability to function independently and manage own time and work tasks.
• Ability to maintain Quality Assurance, Productivity and other Key Performance Indicator (KPI) expectations/standards.
• Ability to maintain confidentiality.
• Performs other duties as assigned.

What You Will Need:

• High school graduate or equivalent.
• 1-3 years of prior relevant experience; Billing, Insurance and/ or Healthcare Financials
• Relevant experience may be substituted for formal education
• What Would Be Nice To Have:
• Associates Degree and or Revenue Cycle certifications.
• Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service.
• Knowledge of insurance and governmental programs, regulations, and billing processes e.g., Medicare, Medicaid/Medi-Cal, Social Security Disability, Champ VA, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.
• Working knowledge of medical terminology and anatomy and physiology is preferable.

The annual salary range for this position is $42,900.00-$64,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.