Insurance Verification Rep

CommonSpirit Health • The Woodlands, TX

2d

About The Position

Under general supervision, Insurance Verification Representative is responsible for verifying patient's insurance information and obtains authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to insurance verification questions. Work closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained. Ensure insurance coverage by telephone. Resolve any issues with coverage and escalates complicated issues to manager. Interview patients and completes all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance. Coordinate with clinical staff to obtain charge information for all patients. Code procedures performed and diagnosis on charge. Assign appropriate ICD-9, CPT and HCPCS code(s) to accurately support the need and documentation for each service. Coordinate copies of medical documentation with physician charges to support billing to third-party payers. Identify physician services provided, but not accurately documented in the medical record. Resolve routine patient billing inquiries and problems.

Requirements

• High School Diploma/GED
• 2 – 4 years healthcare experience required

Responsibilities

• verifying patient's insurance information
• obtaining authorization prior to scheduled visits
• interpreting coverage limitations
• following up with payors/patients to secure account
• responding to insurance verification questions
• ensuring authorizations cover the services needed
• ensuring correct information is obtained
• ensuring insurance coverage by telephone
• resolving issues with coverage
• escalating complicated issues to manager
• interviewing patients and completing all paperwork
• coordinating with clinical staff to obtain charge information
• coding procedures performed and diagnosis on charge
• assigning appropriate ICD-9, CPT and HCPCS code(s)
• coordinating copies of medical documentation with physician charges
• identifying physician services provided, but not accurately documented
• resolving routine patient billing inquiries and problems

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees