Under the direction of the Department Director/Manager/Supervisor, the Insurance Verifier is responsible for gathering complete and accurate data for the verification process of insurance coverage for all pre-admits, in- patients, scheduled out patients, current and discharged, to ensure the patient account is ready for billing and collections per hospital and department policy and procedures. Verifies insurance eligibility/benefits by phone fax or website to obtain authorizations, and determine requests and accurately documents patients' financial responsibility.

PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

1. Maintains, reviews and controls daily in-house admissions documents daily.


2. Obtains insurance eligibility, prior approval and prior authorization from Insurance carriers.


3. Obtains patient signatures on all needed documents such as Consent for Care or missing information as related to Medicare or Tricare etc.


4. Phones patients to obtain insurance and COB information, inform them of financial responsibility and discusses various payment options.


5. Updates, changes or adds demographic and billing information in the EPIC system.


6. Contacts all insurance carriers, per the patient's information, to ensure proper coordination and reimbursement of benefits.


7. Breaks down managed care contract reimbursement and estimates patient's financial responsibilities.


8. Works with physician offices to ensure proper authorization is obtained.

JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES


• Review and analysis outstanding balances on all accounts and determine the next action to be taken. (Example: insurance follow-up, patient follow-up, adjustments, bad debt referral etc).


• Verifying patient benefits


• Actively pursue approval from insurance companies using telephone calls or letters.


• Update EPIC systems on all accounts that need billing to insurance.


• Update EPIC all patient demographic corrections as needed.


• Handle and resolve problem accounts, recommending appropriate disposition if needed to management.


• Handle any phone calls or patient walk in's and resolve or refer to appropriate personal any issues.


• Document all activity done on each account on the EPIC system


• Enter the proper billing indicators/ account note types on each account work for productivity tracking.


• Knowledge of UB-04 and 1500 billing preferred.


• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.


• Ability to prioritize job functions, work independently and exercise good judgment.


• Must possess good written and verbal communication skills.


• Must possess good organizational/analytical skills and mathematical aptitude.


• Proficient use of calculator and minimum typing (55 wpm).


• Basic personal computer skills.

EDUCATION

• High School Diploma/GED Equivalent Required


• Associates Business Preferred


• Healthcare/Medical - Business Office Required

STANDARDS OF BEHAVIOR

Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.


CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE

Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.


DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.