Insurance Verifier - Patient Access - Full Time/Days - Req#2047105069

Job Objective:

Under the supervision of the Department Supervisor, or designee, performs insurance eligibility verifications and obtains authorizations for treatment when required in a timely manner. Communicates updated patient data and pertinent review requirements to other departments such as Patient Care Coordination, Business Office, and other hospital departments as needed. Ensures accuracy of registration information for correct billing and makes corrections when necessary. Counsels patients and provides general information about their insurance plan when requested.

Primary Duties and Responsibilities:

Insurance Verification

• Determines current eligibility status for inpatient and outpatient treatment and records Information on all patient accounts
• Verifies benefit levels to determine adequate coverage for services received and records details on all patient accounts
• Identifies potential non-covered expenses and communicates information to the patient and appropriate hospital staff

Authorization Obtainment

• Identifies authorization requirements for inpatient and outpatient treatment and secures approval from insurance company in a timely manner
• Documents and communicates concurrent review requirements to Patient Care Coordination for timely clinical review to prevent insurance denials

Secondary Duties as Assigned:

Financial Counseling

• Identifies old, outstanding patient liabilities and calculates patient liability for proposed services in order to determine with patient how to resolve existing and projected liabilities and collects monies, as appropriate
• Provides referral to external agencies and/or third party vendors, which provide financial assistance for medical care, through various government programs
• Provides information and assists patients with the completion of the Payment Assistance application
• Analyzes patients' ability to meet financial obligations and sets up appropriate payment plans
• Identifies patients with special financial circumstances to assist in resolving current and future liabilities
• Acts as an information resource for AVH personnel, who are seeking answers to financial concerns for their patients

Non-Essential Duties:

• Assist with registration/pre-registration of patients when assigned
• Assist with other duties as assigned, within skill sets and abilities
• Accepts and carries out all other miscellaneous clerical and/or administrative duties and responsibilities as required for maintaining all services provided by the Admitting Services Department

Knowledge, Skills and Abilities:

Knowledge

• Knowledge of medical terminology
• Knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement
• Knowledge of Managed Care contract language and interpretation
• Knowledge of Microsoft Office applications
• Knowledge of basic arithmetic

Skills

• Basic personal computer skills to include Microsoft Office applications
• Knowledge of the use of a calculator
• Proficient in the operation of scanners, copiers, and fax machines

Abilities

• Ability to handle stress
• Ability to manage a heavy case load in an organized and efficient manner
• Ability to recommend appropriate account adjustment and write-off suggestions
• Ability to recognize potential accounts receivable related problems and offer solutions to management
• Ability to maintain a working relationship with other departments within the organization
• Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges
• Ability to document account information at time of account follow-up
• Ability to run accounts receivable reports as needed

Core Competencies: All AVH employees will effectively demonstrate these behaviors: Accountability Action Oriented Customer Focused Compassion Effective Communication Teamwork Ethics & Values Integrity & Trust

Education and Experience:

Education

• High School graduate or equivalent

Experience

• 1 year recent experience in an Admitting Department in an acute care setting required. Will consider 1 year recent acute care hospital Business Office experience
• 1 years previous Commercial, HMO, PPO, and Workers Compensation billing and/or insurance follow-up experience, preferred

Required Licensure and/or Certifications:

None

AVH Conduct/Compliance Expectations:

Ability to adhere with AVH Leaves of Absence Policy Ability to adhere with AVH Paid Time Off (PTa) Policy Ability to adhere with AVH Recording of Hours Worked Policy Ability to adhere to the department dress code Ability to organize work and establish priorities Ability to expand on own initiative in performance of duties Skill and ability to follow the telephone etiquette/standards Conforms to AVH Standards of Excellence Ability to function effectively under pressure and meet time parameters Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH Ability to maintain the confidentiality of patient, hospital and department information Ability to adhere to safety rules and regulations Safely and effectively uses all equipment necessary to carry out duties Ability to interpret and function under hospital and department poliCies and procedures Conforms with required and appropriate JCAHO requirements Conforms with and supports hospital quality assurance and improvement guidelines Ability to participate effectively in department and hospital staff education Display a willingness to work as a team player Ability to give and support the highest level of patient/customer satisfaction at all times Supports and adheres to the values and mission statement established by the AVH Board of Directors Ability to demonstrate knowledge and understanding of Corporate Compliance rules and regulations, complies with duty to report behavior standard, demonstrates understanding of purpose for Corporate Compliance hotline and importance of seeking guidance from a supervisor when in doubt regarding a possible corporate compliance issue

Physical Requirements and Working Conditions:

• Primarily works in a climate-controlled area
• Frequent Sitting and standing for long periods of time
• Tolerate repetitive arm and hand movements

A detailed description of the physical requirements of this job is maintained in the Employee Health Department.

Education and Experience:

Education

• High School graduate or equivalent

Experience

• 1 year recent experience in an Admitting Department in an acute care setting required. Will consider 1 year recent acute care hospital Business Office experience
• 1 years previous Commercial, HMO, PPO, and Workers Compensation billing and/or insurance follow-up experience, preferred

Required Licensure and/or Certifications:

None