IMH Insurance Verifier, Full Time - Days

Insurance Verifier

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, 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, they will 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. They will perform all clerical processing for completion and disposition of assigned accounts, handle patient and third-party payer inquiries as needed, makes 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

• Responsible for obtaining daily work list assigned to the employee to begin financial clearance process prior to the date of service for elective scheduled services and within payer guidelines for the notification of admission. Obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation.
• Handles all add-ons as assigned per work list, this includes STAT cases that need to be worked as priority per department policy
• Secure all required clinical documentation needed to obtain the authorization
• Maintain that all encounters needing verification is completed within 48 hours
• Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained.
• Handling phone calls from insurance companies, doctor offices and internal departments
• Staying abreast of all insurance verification rules and regulations
• Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement
• Documents the hospital operating system with all pertinent information to support the claim if applicable. This includes the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.
• Requires the ability to sufficiently understanding insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients' out-of-pocket liabilities
• Run medical necessity as needed per payer
• Collects out-of-pocket liabilities from patients upfront and applies, adjusts, and reconciles daily point-of-service cash reports
• Communicates the estimated out of pocket liability for the visit.
• Refers self-pay patients to Financial Counseling for self-pay screening to determine if the patient is qualified for additional financial assistance.
• Refers patient accounts to financial counselors when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.
• Performs other clerical duties as assigned by Manager, Patient Access and / or supervisor(s)
• Handle a variety of task with speed, and attention to detail and accuracy.

Required Qualifications

• High school graduate or equivalent is required.
• Requires two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third party, payor/regulatory agency requirements.
• Requires good analytical and problem-solving ability

Preferred Qualifications

• Some Medical Terminology
• Requires good analytical and problem-solving ability
• Excellent customer service skills
• Typing required (minimum 25-30 wpm)
• Experience in 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