INSURANCE VERIFIER I

As part of the Behavioral Health Insurance Verifier is responsible for financial clearance of all patients assigned to their work list/queue. This also includes on-going support of the ancillary services, central scheduling and outpatient registration for addons, STAT issues or accounts in questions. This role will have a very close working relationship with billing to address denials and appeals as needed. Key Job Activities: Runs daily work list assignments from designated EHR to ensure patients on assigned work list are financially cleared for services. Uses the EHR integrated eligibility system in use including daily review of pre-registration errors, these alerts should be corrected as close to real time as possible. Responsible for insurance verification, including authorization, benefits, and eligibility on all patients within the assigned work list at least one week prior to arrival. (Exceptions will be granted for add on cases, difficult accounts, etc.) Maintains that all encounters have verification done with 48 hours prior to service. Ensures any necessary third-party authorizations are secured as deemed by payer in a timely and accurate manner. Collaborates as needed with billing on denied claims and appeals in a timely manner to resolve discrepancies and expedite payment. Collaborates with ancillary departments and referring clinics to ensure correct services are ordered and authorized prior to the service date. Uses Payment Estimator any similar tool in place to determine cost of service and familiarity with contracted survives/insurances. Contacts patients as necessary prior to the date of service to discuss their financial responsibility per their insurance guidelines after determined by using the charge master, co-insurance percentage and OOP, etc., and follows department polices related to collection efforts. Is familiar with regulatory compliance related to medical necessity; also has a working knowledge of CPT/ICD/HCPC codes. Enters all pertinent information into the EHR notes. Assists in Central Scheduling and/or another service line if needed. This requires all Insurance verifier to be familiar with requirements of all ancillary service areas Responds to patients, families, offices, by the end of the business day. Keeps abreast of insurance verification rules, regulations, and new requirements. Performs other duties as assigned. #J-18808-Ljbffr Sinai Chicago