Insurance Verification Rep - Centralized
City/State: Fredericksburg, Virginia
Category: Support Services
Position Hours: 40Apply
Job Requisition Number: R-896
Job Department: 1007025 MWHC-Centralized Scheduling
Job Posted Date: Nov 12, 2020
Start the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:
The Insurance Verification Rep – Centralized obtains insurance authorization, eligibility, and screens accounts for financial clearance and patient liability for patients who seek services at Mary Washington Healthcare. This position plays a key role in the organization’s front-end revenue cycle processes.
Essential Functions & Responsibilities:
- Monitors reports and/or work queues to ensure timely notification and insurance verification processing.
- Processes insurance verifications through various systems and websites.
- Utilizes multiple resources to verify eligibility, coverage, and obtain necessary documentation to ensure authorization/pre-authorization requirements have been met.
- Facilitates insurance requests for Peer-to-Peer clinical requirements with physicians/practices.
- Confirms authorization is appropriate for scheduled service(s), data span, facility, etc
- Provides insurance company and third-party payors with required clinical documentation to secure authorization.
- Analyzes data to ensure accuracy of authorized procedure (Common Procedure Terminology/CPT) and scheduled visit.
- Oversees clinical documentation and physician orders within the patient medical record, to meet clinical coding initiatives and support necessity of performed procedures.
- Maintains proficiency and knowledge of insurance payers, compliance, and requirements.
- Understands the workflow of the entire patient access process and works with the Team to ensure efficient workflow management.
- Initiates admission notifications to payers. Communicates patient/guarantor financial responsibility, co-pay, deductible, and/or self-pay balance.
- Audits Centers for Medicare and Medicaid (CMS) In-patient only procedure listing for scheduled surgeries.
- Ensures patient status is correct based on government reimbursement regulations.
- Coordinates patient status changes with physicians, Care Managements and other clinical areas to meet federal guidelines and to ensure appropriate reimbursement for MWHC.
- Screens accounts to ensure compliance with medical necessity checks.
- Collaborates with ordering physician/practice to ensure front end edits are corrected.
- Coordinates services with appropriate Registration staff for accounts not meeting medical necessity qualifications.
- Reviews patient data for accuracy and completeness of demographic and insurance information and reviews and makes appropriate changes when needed.
- Reports audit findings and identifies and recommends process improvements within the registration and insurance verification processes.
- Secures accounts for services in a timely manner.
- Communicates any non-secured accounts with patients, provides patients with patient waiver and financial liability details, coordinating rescheduling of services when deemed necessary.
- Performs other duties as assigned.
- High school diploma or equivalent required.
- Healthcare, registration, and insurance experience required.
- Familiarity with diagnostic and/or surgical procedures in a hospital setting required.
- Ability to explain benefits details and authorization requirements to internal and external customers required.
- Proficient computer skills relevant to the position required. Office 365 (to include Outlook), Word and Excel preferred.
- Strong verbal and written communication skills required.
- Strong customer service and telephone skills required.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.