Insurance Eligibility Spec, PD

Position Summary: The Insurance Verification Representative is responsible for timely and accurate verification of medical insurance benefits for both admission and pre‑admission visits. The verifier obtains current eligibility, verifies benefit coverage, and ensures accurate information (pre‑certification, authorizations, and tracking numbers) is documented into the registration system to secure reimbursement. The role requires knowledge of insurance contracts, ability to work from workqueues, and to assist with training new staff. It is multi‑task oriented, prioritizes and coordinates essential job functions, and maintains effective working relationships with coworkers, nurses, physicians, and other hospital staff to ensure workflow effectiveness. Essential Functions and Responsibilities Time and Attendance: Adhere to the MHS Time and Attendance policy, clock in and out of MTM accurately, and sign off on MTM by the end of each pay period. Patient Identification: Avoid HIPAA violations by accurately entering patient information into the system and using two patient identifiers. Documentation and Data Entry: Input accurate documentation into the registration system, ensure all verification documentation is complete and scanned into EPIC timely, and enter notes into referral or auth/cert workflow following Admitting department standard work. Customer Service/Professionalism: Interact positively and deliver excellent customer service to patients, visitors, office staff, and hospital staff to maintain workflow effectiveness. Eligibility Verification: Perform insurance eligibility timely and accurately, using appropriate expertise in EPIC, OnBase, RTE, contracts, and websites. Attendance of Meetings and Professional Development: Participate in department‑specific performance improvement plans, training, staff meetings, projects, and engagement surveys. EPIC Work Queue Monitoring/Productivity: Monitor and manage assigned EPIC work queues to ensure immediate bill release; meet daily and weekly productivity requirements. Patient Estimates and OTC Cash Collections: Create patient estimates accurately and timely, notify patients of estimate amounts, compute out‑of‑pocket financial responsibilities, and collect payments prior to services. Insurance Plan Code Selection: Obtain and assign the correct insurance plan code and IPA codes with minimal errors. Workflow Management: Manage multiple duties simultaneously due to high patient volumes. Experience Minimum of 2 years in admitting/registration/insurance verification or equivalent healthcare experience (preferred). Knowledge of insurance and payors. Effective verbal and written communication skills. Strong customer service and computer skills. Education High school diploma or GED (preferred). Medical terminology course (preferred). Bilingual in English/Spanish (preferred). Primary Location: United States, California, Fountain Valley Organization: MemorialCare Health Services Employee Status: Regular Job Level: Staff Shift: Day Job Scheduled Shift Start Time: 600 – Scheduled Shift End Time: 1700 #J-18808-Ljbffr MemorialCare Health System