Pre-Registration/Insurance Verification Representative (Central Insurance Verification)

General Description: Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts.

Essential Responsibilities:

• Performs pre-registration and insurance verification within 24 hours of receipt of reservation/notification for both inpatient and outpatient services
• Follows scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information therein
• Contacts physician to resolve issues regarding prior authorization or referral forms
• Assigns plans accurately
• Performs electronic eligibility confirmation when applicable and document results
• Researches Patient Visit History to ensure compliance with payor specific payment window rules
• Completes Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
• Calculates patient cost share and be prepared to collect via phone or make payment arrangement
• Contacts patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment
• Receives and records payments from patient for services scheduled.
• Utilizes appropriate communication system to facilitate communication with hospital gatekeeper
• Performs insurance verification and pre-certification follow up for prior day's walk in admissions/registrations and account status changes by assigned facility
• Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre- existing, non-covered, and re-certification issues
• Utilizes Meditech account notes and Collections System account notes as appropriate to cut and paste benefit and pre-authorization information and to document key information
• Meets/exceeds performance expectations and completes work within the required time frames
• Implements and follows system downtime procedures when necessary
• Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"

General Responsibilities:

• Other duties as assigned

Minimum Qualifications:

Education: High school diploma or GED required

Experience: At least three years of insurance verification experience preferred

License(s)/Certification(s)/Registration(s) Required: N/A

Knowledge, Skills and Abilities:

• Communication - communicates clearly and concisely, verbally and in writing
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Interpersonal skills - able to work effectively with other employees, patients and external parties
• PC skills - demonstrates proficiency in PC applications as required
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
• Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately