Insurance Verifier - Full Time, Days
Location: Harvey, IL
Shift: Monday - Friday, 8:30am-5pm (possible Saturday shift once every 5 weeks)
Join the hospital trusted by Chicago's Southland, Ingalls Memorial Hospital, in this role as an Insurance Verifier.
Insurance Verifier – Job Summary:
Under the supervision of the Patient Access leadership, initiates the process for all scheduled elective outpatient services and inpatient admissions. This includes verification for observation cases as well as add on procedures. The Insurance Verifier will be responsible for indicating if the services are financially cleared prior to the date of service. The insurance verifier will secure the necessary authorizations to support the services being ordered and in the event of an inpatient admission, they will initiate the notification of admission within the payer guidelines. They will be responsible for staying abreast of payer rules according to policy as well as state and federal billing and collection regulations. They will perform all clerical processing for completion and disposition of assigned accounts, handle patient and third-party payer inquiries as needed, makes necessary follow-up on those arrangements to ensure compliance with appropriate hospital and departmental collection policies and procedures assuring satisfactory disposition of all encounters.
Insurance Verifier – Responsibilities:
- Responsible for obtaining daily work list assigned to the employee to begin financial clearance process prior to the date of service for elective scheduled services and within payer guidelines for the notification of admission.
- Responsible for obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation.
- Handles all add-ons as assigned per work list, this includes STAT cases that need to be worked as priority per department policy.
- Secure all required clinical documentation needed to obtain the authorization.
- Ensure that all encounters needing verification is completed within 48 hours.
- Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained.
- Confirm that all encounters needing verification is completed within 48 hours.
- Handle phone calls from insurance companies, doctor offices and internal departments.
- Remain abreast of all insurance verification rules and regulations.
- Stay informed of state and federal regulations in relation to hospital reimbursement and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement.
- Document the hospital operating system with all pertinent information to support the claim if applicable; including the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.
- Run medical necessity as needed per-payer.
Insurance Verifier – Required Experience:
- High school graduate or equivalent is required.
- Requires two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third party, payor/regulatory agency requirements.
- Some understanding of Medical Terminology.
- Requires good analytical and problem-solving ability.
- Experience in basic computer software programs (Microsoft Word, Excel and Outlook)
- Good written and verbal communication skills.
- Excellent customer service skills.
- Typing required (minimum 25-30 wpm)
Insurance Verifier – Preferred Experience:
- Prior experience verifying insurance and processing prior authorizations.
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