Central Insur Verification Rep

Orlando Health•Melbourne, FL

12d

About The Position

The Central Insurance Verification Rep works as part of a team responsible for verifying insurance for physician, hospital, and surgery appointments. The role verifies coverage, plan and network participation, and benefits; accurately enters insurance details for billing and referral processing; and communicates eligibility issues or information needs to physician offices. The representative also reviews insurance for same-day and future appointments, processes insurance changes, and supports related departmental work while meeting productivity and attendance expectations and complying with Orlando Health policies and procedures.

Requirements

High school diploma or equivalent.
Ability to use electronic verification tools and web-based resources.
Knowledge of commercial and state-funded insurance plans.
Ability to identify HMO, POS, open-access, and PPO plan types.

Responsibilities

Verify insurance plans and network participation for physician offices, hospitals, and ambulatory surgery centers.
Contact payers to verify insurance coverage and benefits.
Verify effective dates, group numbers, claim addresses, copays, deductibles, out-of-pocket amounts, and coinsurance.
Accurately enter insurance information on accounts for billing and referral processing.
Review coverage for same-day appointments and work reports for future appointments.
Rotate with other staff to work reports and immediate-attention forms.
Link the patient or guarantor party to insurance on accounts.
Communicate with physician offices about eligibility issues or to obtain updated information needed to complete verification.
Identify and understand coordination of benefits when needed.
Create account alert notes with information offices need to know.
Note assigned primary care physicians on accounts when applicable.
Make insurance changes to accounts when applicable and notify Accounts Receivable to review accounts in question.
Meet the department's daily productivity goal.
Maintain reasonably regular and punctual attendance consistent with applicable policies and standards.
Comply with Orlando Health policies and procedures.
Research missing insurance for services already rendered by working additional reports.
Assist other team members as needed.
Work on assigned projects.
Attend and participate in department staff meetings as assigned.