Insurance Verification Rep

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Under general supervision, Insurance Verification Representative is responsible for verifying patient’s insurance information and obtains authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to insurance verification questions.
Work closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.

1. Ensure insurance coverage by telephone.
2. Resolve any issues with coverage and escalates complicated issues to manager.
3. Interview patients and completes all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance.
4. Coordinate with clinical staff to obtain charge information for all patients.
5. Code procedures performed and diagnosis on charge.
6. Assign appropriate ICD-9, CPT and HCPCS code(s) to accurately support the need and documentation for each service.
7. Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
8. Identify physician services provided, but not accurately documented in the medical record.
9. Resolve routine patient billing inquiries and problems.
10. Perform other duties as assigned.

Required Education and Experience

* Bachelor degree in related field preferred.
* 2 – 4 years healthcare experience preferred.

Required Minimum Knowledge, Skills, Abilities and Training

* Thorough understanding of insurance payor reimbursement, collection practices, and accounts receivable follow-up required.
* Broad knowledge of the content, intent and application of HIPAA, federal and state regulations.
* Understanding of insurance payor reimbursement and collection practices.
* Knowledge of insurance industry and basic medical terminology/abbreviations preferred.
* Understands health insurance and medical costs, including coding.
* Requires good customer skills.
* Good communication skills.
* Proficient computer skills.
* Possess a strong work ethic and a high level of professionalism.