Position Title:
Pre-Registration/Insurance Verification Representative (Central Insurance Verification)
Department:
Admitting
Job Description:
General Description: Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts.
Essential Responsibilities:
- Performs pre-registration and insurance verification within 24 hours of receipt of reservation/notification for both inpatient and outpatient services
- Follows scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information therein
- Contacts physician to resolve issues regarding prior authorization or referral forms
- Assigns plans accurately
- Performs electronic eligibility confirmation when applicable and document results
- Researches Patient Visit History to ensure compliance with payor specific payment window rules
- Completes Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
- Calculates patient cost share and be prepared to collect via phone or make payment arrangement
- Contacts patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment
- Receives and records payments from patient for services scheduled.
- Utilizes appropriate communication system to facilitate communication with hospital gatekeeper
- Performs insurance verification and pre-certification follow up for prior day’s walk in admissions/registrations and account status changes by assigned facility
- Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre- existing, non-covered, and re-certification issues
- Utilizes Meditech account notes and Collections System account notes as appropriate to cut and paste benefit and pre-authorization information and to document key information
- Meets/exceeds performance expectations and completes work within the required time frames
- Implements and follows system downtime procedures when necessary
- Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
General Responsibilities:
Minimum Qualifications:
Education: High school diploma or GED required
Experience: At least three years of insurance verification experience preferred
License(s)/Certification(s)/Registration(s) Required: N/A
Knowledge, Skills and Abilities:
- Communication - communicates clearly and concisely, verbally and in writing
- Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- Interpersonal skills - able to work effectively with other employees, patients and external parties
- PC skills - demonstrates proficiency in PC applications as required
- Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
- Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.