Insurance Verification Clerk

Coordinates activities within the Business Office in the areas of Admissions, Scheduling, Insurance Verifications/Pre-Certifications, and Medical Records. Also responsible for contacting patients regarding their financial responsibility. This role will be highly focused on insurance verification and pre-certifications. Typical schedule will be weekdays 9am-5pm.

Qualifications

• High School Diploma, Associates Degree preferred
• Experience in a surgical facility preferred
• Ability to interface with insurance carriers, with a strong understanding of patient benefits
• Strong written and verbal communication skills required, able to speak effectively to internal and external customers required
• Strong working knowledge of Microsoft Outlook, Word and Excel

Essential Functions

Insurance Verifications/Pre-Certifications

• Act as liaison between patient, physician office, and insurance company to assist patients with regards to financial responsibility
• Notify all scheduled patients of their financial responsibility prior to their date of service
• Verify patient insurance eligibility and benefits using technology tools, the telephone and the internet to ensure compliance with the facilities policies and procedures
• Coordinate with insurance providers and the physician office to obtain pre-authorizations. Document the authorizations in the system patient accounts
• Obtain information for medical necessity determination and coordinate with the physician office if additional information is needed
• Communicate with patients to obtain any missing information necessary to achieve financial clearance.
• Perform Benefit verifications on all new patients
• Obtains and verifies patient demographic and financial information

Admissions

• Admits patients to the Facility following the established policies and procedures
• Collect patient out of pocket responsibilities at the time of check in, acknowledge collection on the SC1000 Scheduling Report, and sign off on daily receipts
• Assembles patient medical record forms and prepares patient identification
• Provides pertinent information to the patient’s family in the waiting area according to policies and procedures
• Answers telephone and intercom courteously and in a quiet, pleasant voice
• Maintains and protects each patient’s right to confidentiality
• Identifies emergencies and initiates appropriate response

Scheduling

• Considers priorities and special needs when scheduling surgical procedures
• Maintains schedule according to policies on nursing and anesthesia staff availability, patient needs and physician’s block time
• Coordinates schedule in a manner to minimize conflict, and adjusts schedule as appropriate

Medical Record

• Check each medical record for completeness, marking and attaching a deficiency slip as needed
• Performs release of information functions as necessary, per facility policy, state and federal regulations, and HIPAA guidelines
• Maintain a log of record requests received, processed, and mailed out
• Assist Medical Staff with completion of medical records

General Business Office

• Cross train as required to assist with overflow responsibilities
• Exhibit flexibility in work schedules and assigned tasks
• Maintains minimal error rate
• Participates in group meetings and/or various committees
• Makes suggestions on workflow improvements
• Notifies Business Office Manager of any issues
• Maintains a positive attitude toward their position and responsibilities
• Other duties and project work as requested

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.

The employee must be able to lift and/or carry over 20 pounds on a regular basis and be able to push/pull over 25 pounds on a regular basis.

The employee must be able to stand and/or walk at least five hours per day.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.