Insurance Verification Representative - Full-Time

1. Consistently demonstrates professional and customer service focused behavior at all times, including manner of communication, responsibility and appearance. 
2. Calls insurance company, or verifies online, to obtain eligibility and benefit information for all inpatients admitted day(s) prior since last business working day, all outpatient surgeries and all future pre-admissions and outpatient test/procedures. 
3. Checks daily admission reports, and/or surgical procedures, outpatient schedules to ensure all patients are accounted for.
4. Calls, or obtains online, any required referrals, pre-authorizations or pre-certifications, RQI or tracking numbers for applicable accounts to assure reimbursement and minimize denials.
5. Enters complete and accurate notes in HWS regarding benefits, pre-authorizations, UR review requirements, patient payment arrangements and other pertinent information in a timely manner. 
6. Reviews and updates incorrect patient, guarantor or insurance information entered in the Meditech Expanse Admissions module as necessary. Uses existing tools/resources I order to minimize denial of claim/lost revenue.
7. Calls patients with group or private health insurance that has a deductible, co-pay or co-insurance to meet, explains benefits and payment options and makes appropriate deposit and initial payment arrangements or provides information about our financial assistance program. Refers to Financial Counselor any patient who expresses reluctance, difficulty or concerns with regard to timely payment of existing financial liabilities.
8. Refers to Financial Counselor any patient whose benefits are inadequate, terminated or whose benefits cannot be verified after checking for further or new information with the patient, the patient’s employer or any other available resource.
9. Follows up with insured patients involving third party liability (WC, personal injury, auto accident, etc.) and ensures appropriate forms are completed and signed (as necessary) and scanned into HWS.
10. Notifies appropriate individuals (Case Manager and/or Mgr, Physician, etc) whenever a Medicare inpatient has 5 or less available benefit days and/or patient’s insurance is terminated. Obtains consent to use Lifetime Reserve Days for Medicare patients who have exhausted available renewable benefit days.
11. Notifies director regarding admission and registration quality and assists in identifying potential performance issues and training and educational opportunities. 
12. Performs other duties as requested by director.

The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.