Insurance Verification Representative II

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct pre-registration and verify insurance for both inpatient and outpatient services.

• Adhere to the scripted benefits verification and pre-certification procedures in the EMR, documenting outcomes accordingly.

• Reach out to patients to confirm or gather any missing demographic information, provide quotes or collect patient cost shares, and offer appointment instructions.

• Accurately assign insurance plans and perform electronic eligibility verifications.

• Complete the Medicare Secondary Payor Questionnaire as needed.

• Calculate patient cost shares and organize payment or collection through phone interactions.

• Investigate patient visit histories to ensure compliance with payor-specific regulations, including the Medicare 72-hour rule.

• Collaborate with physicians and case managers to address authorization or referral challenges.

• Record benefit and authorization details in standard EMR screens and notes.

• Execute system downtime protocols when required.

• Uphold the organization’s Code of Conduct and Mission and Value Statement.

• Oversee daily operations and assist staff with intricate insurance verification matters.

• Monitor and reconcile reports to ensure timely and accurate processing.

• Support quality assurance processes and assist management during audits.

• Mentor new employees and provide continuous guidance to team members.

• Act as the primary contact for escalated issues involving physicians, insurance companies, and case managers.

• Ensure adherence to Medicare and other payor-specific regulations and standards.

• Maintain documentation standards within the EMR.

• Coordinate with various hospital departments and enhance communication across teams.

• Assist with coverage staffing and prioritize workflow effectively.

• Undertake special projects and additional tasks as assigned by management.

• Execute other duties as required.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Minimum of 3 years of experience in hospital Patient Access is essential.

• Certification as a Revenue Cycle Representative (CRCR) from the Healthcare Financial Management Association (HFMA) or as a Certified Healthcare Financial Professional (CHFP) from HFMA is required within 180 days of employment.

• Exceptional communication and leadership capabilities.

• Robust analytical and problem-solving skills.

• Proficiency in EMR systems is necessary.

• Capability to mentor and assist team members effectively.

• High accuracy and meticulous attention to detail are crucial.

• Ability to perform duties with or without reasonable accommodation.

• Familiarity with Medicare and other payor-specific regulations and guidelines.

• Competence in following scripted benefits verification and pre-certification formats.

• Skill in calculating patient cost shares and arranging payment or collection via telephone.

🏝️ Benefits

• Comprehensive benefits package offered.

• Paid Time Off (PTO).

• 401(k) retirement plan.

• Medical insurance options available.

• Dental insurance plans provided.

• Total benefits and compensation package designed to meet needs both inside and outside of the work environment.