IMH Insurance Verifier, Full Time - Days

Job Description Be part of a world‑class academic healthcare system, Ingalls Memorial Hospital, as an Insurance Verifier. This position will be primarily a work‑from‑home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. The Insurance Verifier is under the supervision of the Patient Access leadership and initiates the process for all scheduled elective outpatient services and inpatient admissions. This includes verification for observation cases as well as add‑on procedures. The insurance verifier will be responsible for indicating if the services are financially cleared prior to the date of service. The insurance verifier will secure the necessary authorizations to support the services being ordered and, in the event of an inpatient admission, initiate the notification of admission within the payer guidelines. They will be responsible for staying abreast of payer rules according to policy as well as state and federal billing and collection regulations. The insurance verifier will perform all clerical processing for completion and disposition of assigned accounts, handle patient and third‑party payer inquiries as needed, make necessary follow‑up on those arrangements to ensure compliance with appropriate hospital and departmental collection policies and procedures, assuring satisfactory disposition of all encounters. Essential Job Functions Obtain the daily work list assigned to begin the financial clearance process prior to the date of service for elective scheduled services and within payer guidelines for the notification of admission; obtain authorization for the services rendered to ensure proper reimbursement and denial mitigation. Handle all add‑ons as assigned per work list, including STAT cases that need to be worked as priority per department policy. Secure all required clinical documentation needed to obtain the authorization. Ensure that all encounters requiring verification are completed within 48 hours. Notify the patient and the ordering provider if an authorization has been delayed and work with the department to reschedule the services until financial clearance has been obtained. Handle phone calls from insurance companies, doctor offices and internal departments. Stay abreast of all insurance verification rules and regulations. Stay informed of state and federal regulations in relation to hospital reimbursement, and maintain communication with personnel in HIM departments and the business office to ensure accurate reimbursement. Document the hospital operating system with all pertinent information to support the claim if applicable, including the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for documentation, etc. Understand insurance protocols for referrals, co‑payments, deductibles, allowances, etc., and analyze information received to determine patients’ out‑of‑pocket liabilities. Run medical necessity review as needed per payer. Collect out‑of‑pocket liabilities from patients upfront and apply, adjust, and reconcile daily point‑of‑service cash reports. Communicate the estimated out‑of‑pocket liability for the visit. Refer self‑pay patients to Financial Counseling for screening to determine if the patient is qualified for additional financial assistance. Refer patient accounts to financial counselors when further explanation/education is needed regarding denied authorizations, out‑of‑pocket liabilities, coverage options, payment plans, etc. Perform other clerical duties as assigned by the Manager, Patient Access and/or supervisor(s). Handle a variety of tasks with speed, attention to detail and accuracy. Required Qualifications High school graduate or equivalent. Two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third‑party payer/regulatory agency requirements. Good analytical and problem‑solving ability. Preferred Qualifications Some medical terminology. Excellent customer service skills. Typing required (minimum 25‑30 wpm). Experience with basic computer software programs (Microsoft Word, Excel, and Outlook). Good written and verbal communication skills. Position Details Job Type: Full Time (1.0 FTE) Shift: Days (Rotational) Department: Insurance Verifier Office Location: Ingalls Memorial Hospital – Harvey (no set days in office – on as needed basis) CBA Code: Non‑Union #J-18808-Ljbffr