Role Description
The Insurance Verifier obtains necessary patient information from physicians' offices. The Insurance Verifier also determines how much money to collect from the patient up front and what reimbursement is expected from the insurance company.
Qualifications
• High School Diploma or GED equivalent.
• Minimum of 2 years of experience in a medical office setting.
• Insurance verification and calculation of benefits experience preferred.
• Experience with WayStar, Availity, and other insurance plans.
• Bilingual preferred but not required.
• Strong understanding of benefits investigating, deductibles, co-insurance, out of pocket expense & benefit exclusions.
Requirements
• Verify insurance eligibility and benefits for specific CPT and diagnosis codes.
• Determine if physician and facility are credentialed with the plan either by telephone or the provider website.
• Perform insurance pre-certification, verification, and document information accordingly.
• Verify and obtain all patient eligibility, authorizations, benefits, claim information with insurance companies, and 3rd party payers within the industry standard of 3-5 business days prior to date of service.
• Determine and document patient portions due, amounts to be billed, contractual discounts to be taken, or any other authorized discounts that may apply.
• Communicate this information with appropriate personnel for preparation of the pre-admission process.
• Identify all patient accounts accurately based on what PPO, HMO, or other Managed Care Organizations the patients insurance plan might fall under.
• Contact patients and provide updates on benefit verification information, request additional information, insurance cards, and explain to the patient his or her financial responsibility such as co-pays, co-insurance, co-deductibles, at time of service.
• Accurately complete data entry necessary including authorizations and benefits as well as patient communication in the appropriate software.
• Make financial arrangements after consulting with Revenue Cycle Manager and/or Physician when patient is unable to pay amounts due in full the date of service.
• Document all information in PM System, EMR system, and ASC PM.
• Notify Revenue Cycle Manager of any insurance carrier information changes.
• Attend required meetings and participate in committees, as requested.
• Other duties as assigned based on business operational needs.
Benefits
• Continuing Education including JCAHPO & ABOC
• Holidays & Paid Time Off
• Bereavement Leave
• Superior Benefits Package:
• Medical
• Dental
• 401(K)
• Free Life Insurance & LTD
• Eye Care Benefits & Optical Discounts