[Hiring] Insurance Verification Representative II @OU Health

Role Description

The Insurance Verification Representative II is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. This role serves as a lead within the department by performing advanced duties and assisting with staffing, quality assurance, reporting, and training.

Essential Responsibilities

• Perform pre-registration and insurance verification for inpatient and outpatient services.
• Follow scripted benefits verification and pre-certification format in the EMR and document results.
• Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.
• Assign insurance plans accurately and perform electronic eligibility confirmation.
• Complete Medicare Secondary Payor Questionnaire as applicable.
• Calculate patient cost share and arrange payment or collection via phone.
• Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).
• Communicate with physicians and case managers to resolve authorization or referral issues.
• Document benefit and authorization information in the standard EMR screens and notes as needed.
• Implement system downtime procedures when necessary.
• Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.
• Lead daily operations and assist staff with complex insurance verification issues.
• Monitor and reconcile reports to ensure timely and accurate processing.
• Support QA processes and assist management with audits.
• Train new staff and provide ongoing guidance to team members.
• Serve as point of contact for escalated issues with physicians, insurance companies, and case managers.
• Ensure compliance with Medicare and other payor-specific rules and regulations.
• Maintain documentation standards in the EMR.
• Coordinate with hospital departments and facilitate communication across teams.
• Assist with staffing coverage and workflow prioritization.
• Perform special projects and other duties as assigned by management.

Qualifications

• High School Diploma or GED required.
• 3 or more years of experience in hospital Patient Access required.
• Certified Revenue Cycle Representative (CRCR) issued by the Healthcare Financial Management Association (HFMA) or Certified Healthcare Financial Professional (CHFP) issued by HFMA required within 180 days of hire.
• Advanced communication and leadership skills.
• Strong analytical and problem-solving abilities.
• Proficiency in EMR systems.
• Ability to mentor and support team members.
• High level of accuracy and attention to detail.

Benefits

• Comprehensive benefits package, including PTO.
• 401(k) plan.
• Medical and dental plans.
• Additional benefits designed to meet specific needs both inside and outside of the work environment.