Insurance Eligibility Spec, PD

MemorialCare•Fountain Valley, CA

5d•Onsite

About The Position

The Insurance Verification Representative is responsible for timely and accurate verification of medical insurance benefits for both admission and pre-admission visits. The Insurance Verifier will obtain current eligibility, verify benefit coverage, and ensure accurate information is obtained (pre-certification, authorizations & tracking numbers) and documented into the registration system to secure reimbursement. The Insurance Verifier must be knowledgeable with insurance contracts. Ability to work from workqueues and assist with training new staff. Multi-task oriented with the ability to prioritize and coordinate the essential job functions. Maintains effective working relationships with coworkers, nurses, physicians, and other hospital staff members in order to insure workflow effectiveness. This position requires full understanding and active participation in fulfilling the mission of Memorial Care. It is expected that the employee demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion and Synergy. The employee shall support the MemorialCare Health Systems strategic plan and participate in and advocate performance improvement/patient safety activities.

Requirements

Minimum of 2 years in admitting/registration/insurance verification or equivalent healthcare experience preferred.
Knowledge of insurance and payors.
Ability to communicate effectively verbally and written.
Must have strong customer service and computer skills.
High school diploma or GED preferred.
Medical terminology course preferred.
Bilingual (English/Spanish) preferred.

Responsibilities

Timely and accurate verification of medical insurance benefits for both admission and pre-admission visits.
Obtain current eligibility, verify benefit coverage, and ensure accurate information is obtained (pre-certification, authorizations & tracking numbers) and documented into the registration system to secure reimbursement.
Work from work queues and assist with training new staff.
Maintain effective working relationships with coworkers, nurses, physicians, and other hospital staff members to ensure workflow effectiveness.
Accurately enter patient information into the system, adhering to policy of using 2 patient identifiers to avoid passing on defects such as, incorrect PCP, guarantor, IPA, health plan, subscriber, W/C, guarantor etc.
Input accurate documentation into the registration system to secure reimbursement.
Ensure that all verification documentation is complete and scanned into EPIC timely.
Enter notes into referral or auth/cert workflow by following the Admitting department Standard Work regarding patient benefits, out of pocket lifetime max on benefits and effective dates of insurance eligibility.
Interact in a positive and constructive manner and deliver excellent customer service to patients, visitors, office staff and hospital staff members to ensure workflow effectiveness.
Maintain an effective and professional working relationship with co-workers and others.
Perform insurance eligibility timely and accurately.
Utilize expertise in EPIC, OnBase, RTE, contracts and websites to ensure accurate and efficient reimbursement.
Participate in department-specific performance improvement plans (e.g., education/training, staff meetings, projects, Press Ganey employee engagement survey, Simply Better and Service excellence, etc.).
Monitor/manage assigned EPIC work queues ensuring immediate bill release.
Meet the department’s daily productivity requirements to maximize productivity by meeting the Admitting department weekly goals.
Create patient estimates accurately and timely.
Notify patients of estimate amount via phone and mailed letter.
Compute patient estimates and advise patients of their financial responsibility, including deposits, co-pays, deductibles, estimates, and co-insurance timely and accurately.
Collect out-of-pocket financial liabilities from patients prior to scheduled services being rendered.
Obtain and assign the correct insurance plan code and IPA codes with minimal errors.
Multitask and perform multiple duties at a time due to the high patient volumes for MemorialCare Health Systems.
Other duties as assigned.