[Hiring] Insurance Verification Specialist @Wellstar Health System

Role Description

The Insurance Verification Specialist will verify patient information and confirm all insurance payer plans present on the account are up to date. If no insurance is present on the account, will research EPIC history for recent visit payer information. Will utilize contact with physician practice or patient to obtain form of coverage as needed. Escalates for approval as appropriate to avoid patient delays in service. Specialist responds to questions from patients, clerical staff, and insurance companies professionally. Updates account and maintains accuracy and confidentiality. Maintains established productivity benchmarks and meets goals in a fast-paced environment. Other duties as assigned.

Core Responsibilities and Essential Functions

• Budget/Financial
  • Attempts to collect the estimated self-pay balance of all inpatient, outpatient, and ER accounts, at the earliest possible collection control point.
  • Monitors in-house accounts and attempts to make financial arrangements with guarantors for payment of their self-pay balances in full and prior to discharge.
  • Completes financial evaluation forms to document guarantors' income, expenses, assets, and liabilities.
  • Identifies patients without adequate insurance coverage and makes personal contact with patient or guarantor to determine ability to pay non-covered charges and potential eligibility for financial assistance programs (namely Medicaid).
  • Maintains a list of health care financial assistance programs and the eligibility requirements for each program.
  • Works efficiently and accurately within designated time frames to ensure continuity of information and cash flow.
  • Contacts scheduled patients at home to obtain pre-admission information, explain financial policies, estimate self-pay balances, and obtain a promise to pay on or before admission/registration.
  • Interviews all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.
  • Documents concise and understandable notes regarding all self-pay account collection activity and each patient or guarantor interaction.
  • Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
  • Verifies insurance coverage and benefits.
  • Exceeds monthly quota on a consistent basis and formally reports results of self-pay collection activity to direct supervisor.
  • Responsible for completion of appropriate error/issues in Work Queues.
  • Identifies and resolves Payor Denials as indicated.
• General
  • Observes work hours and provides proper notice of absences, tardies, and work schedule changes.
  • Attends select departmental meetings at the request of WHS Management.
  • Completes monthly, quarterly, and annual mandatory training as required.
  • Performs other duties as assigned.
  • PAS II Team members serve as preceptors and mentors and must maintain a QA audit registration accuracy rate or higher in the past 12 months.
  • Maintain minimum productivity requirements.
  • Has no corrective disciplinary action during the past twelve (12) months.
  • Willing and able to function as a preceptor in the orientation of new patient access personnel and students.
  • Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board.
• Quality/Safety
  • Prior to a patient's first visit, verify insurance coverage and benefits including co-payments and deductibles and OOP Max.
  • Verify insurance coverage and benefits on a daily basis through Recipient Eligibility Verifications Systems and various payor websites and/or via telephone.
  • Assist in Prior Authorizations, verify the accuracy of demographic and payor information, and notify admissions, scheduling, and other related departments regarding concerns and corrections.
  • Works in conjunction with Prior Authorization specialist to obtain initial and ongoing authorizations for outpatient visits.
  • Receive Explanation of Benefits and Authorizations and enter into the system as required.
  • Keep current on new policies and procedures of third-party payors, hospital procedures, and any insurance updates.
  • Comply with departmental and organizational policies/procedures including but not limited to dress code, telephones, cell phones, and computers.
  • Maintains courteous and cooperative working relationships with WHS management, patients, physicians, and the public.
  • Presents a well-groomed and professional image.
• Customer Service
  • Greets all guests with a positive and professional attitude.
  • Receives patients' valuables for safekeeping in the hospital safe.
  • Answers incoming phone calls and follows through with requests made.
  • Maintains courteous and cooperative working relationships with WHS management, patients, physicians, and other professional contacts.
  • Presents a well-groomed and professional image in coordination with department/hospital dress codes.

Qualifications

• High School Diploma or GED required; Associates preferred.

Requirements

• All certifications are required upon hire unless otherwise stated.
• CHAA - Cert Healthcare Access Assoc or CPAR - Certified Patient Account Rep or CRCR - Certified Revenue Cycle Rep or CRCR-P - Certified Revenue Cycle Rep - Provisional (90 Days) within 120 Days.
• Minimum 1 year experience in healthcare or institutional work setting required.
• Computer/data entry experience required.

Skills

• Ability to communicate with various members of the healthcare team.
• Effective communication skills (both written and verbal), attention to detail, self-directed, and a positive attitude are essential.
• Effective problem-solving and critical thinking skills.
• Working knowledge of patient registration systems and intermediate Microsoft Office Suite preferred.
• Epic experience preferred.

Benefits

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.