Insurance Verification Representative - Bone & Joint Institute

Summary

ABOUT WILLIAMSON HEALTH | Williamson Health is a regional healthcare system based in Williamson County, Tennessee, with more than 2,300 employees across more than 30 locations and more than 860 physicians and advanced care practitioners offering exceptional healthcare across 60-plus specialties and subspecialties close to home. The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women’s services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Other Williamson Health service providers include the Bone and Joint Institute of Tennessee, The Turner-Dugas Breast Health Center, Monroe Carell Jr. Children’s Hospital Vanderbilt at Williamson Medical Center, Williamson Health physician practices that are strategically located throughout the community, countywide Emergency Medical Services that include 18 rapid response units, Williamson Health Foundation, and multiple joint venture Vanderbilt Health and Williamson Medical Center Walk-In Clinics in Williamson County. Learn more about our many specialized services at WilliamsonHealth.org.

Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We’re committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.

Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being. 
o    Medical, Dental, Vision
o    PTO
o    Retirement Matching
o    Tuition reimbursement
o    Discount programs
o    FSA (Flexible Spending Accounts)
o    Identity Theft Protection
o    Legal Aid

Williamson Health is an equal-opportunity employer and a drug-free workplace.

POSITION SUMMARY

Verifies insurance benefits and performs pre-certification on Surgery (Inpatients and Outpatient procedures), Imaging and Pain Injections, to achieve maximum reimbursement in a timely manner. Works closely with other departments and referring physician offices and is professional in all communications.   

POSITION REQUIREMENTS

Formal Education/ Training:
High School diploma or equivalent

Workplace Experience:
At least three years experience in a professional customer service oriented office environment
At least one year Insurance verification and pre-certification experience required
Interprets physician orders and understands radiology and surgery protocols

Equipment and Skills Training:
Meditech, Fax, Copier, time and attendance system, Athena, Education system, hand-held communication equipment, email.

Physical Environment:
Office in all areas pertinent to position

Physical Effort:
Able to communicate in English verbally and legibly
Prolonged sitting, consistent keyboard and terminal usage
Standing, walking, bending, 
Efficient verbal and written communication
Ability to work well under pressure, to function dependently and independently

PERFORMANCE STANDARDS

1. Consistently is up-to-date with payer requirements and is knowledgeable of billing requirements/regulations.  Consistently and accurately verifies insurance benefits/pre-certification requirements by using One Source, insurance websites, insurance cards and contacting insurance company by phone, as need, for all scheduled procedures.  Notes all needed information in patient’s account.  Completely reviews insurance information entered by PSS staff and/or scheduler and updates information accurately to ensure timely reimbursement.
2. Consistently uses good customer service skills when contacting patients, or physician offices when benefits have terminated or insurance information is incomplete or not available upon registration.
3. Consistently reviews Athena to obtain physician orders, clinical information, insurance information and contacts physician office when discrepancies or additional information is needed. 
4. Collaborates with patient service specialists and billing office, as needed, to accurately answer patient questions regarding insurance benefits, pre-certification and coverage.
5. Consistently obtains and verifies prior authorizations and compares to the physician orders to ensure accuracy.  Obtains updated orders as needed.  Relays clinical information and all necessary documentation to insurance companies accurately.  Consistently follows-up on all procedures for authorization/retro authorization in a timely manner.
6. Consistently communicates with and assists schedulers and patient service specialists with daily and future work.
7. Consistently communicates and documents significant patient information in a timely manner to hospital departments and physician offices via outlook or Athena documentation. Acknowledges e-mails in a timely manner.
8. Consistently notifies the financial counselors of self-pay patients or when patients insurance has terminated to make financial arrangements.
9. Understands and willingly adjusts working hours and job duties to accommodate patients and the department.  Recognizes the need for change in daily routine; willingly alters lunch/break schedule to accommodate patient and/or department needs.
10. Communicates with all stakeholders when issues delay treatment due to pre-certification or verification requirements.
11. Participates in departmental meetings/huddles/etc. and recommends improvement opportunities.  Performs other duties as assigned by Director of Operations and/or Utilization Review Manager and independently seeks out job duties during downtime.
12. Reports concerns requiring attention to manager or director.  Is a problems solver that brings possible solutions with the concerns or problems.