Insurance Verification Representative I - Inpatient Rehab - Days

Nevada System of Higher Education•Arlington Heights, IL

6d•$20 - $29•Onsite

About The Position

The Insurance Verification Representative will be under the management of the Manager, Patient Access, the Pre-Certification Representative I is responsible to determine insurance eligibility and, as appropriate benefits, pre-authorization / pre-certification and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative I provide this service to ensure that our customers are provided a high-quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative I help to ensure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized.

Requirements

High School Required
1 Year of experience in a contact center, healthcare environment or customer service role.
And Experience with referrals and pre-certification strongly preferred.
Basic math skills
Basic computer skills
Typing speed of 30 wpm
Demonstrated record of excellent customer service skills
Strong verbal communication skills: ability to speak clearly and articulate to customers and co-workers.
Strong written communication skills to record patient activity in Epic.
Strong active listening skills to effectively assist multiple customer types and identify "panic" or "hot" words.
Ability to display empathy when dealing with customers.
Critical thinking skills
Decision-making and problem-solving skills
Strong attention to detail to accurately enter data and research and resolve questions
Ability to work independently with minimal supervision.
Ability to multi-task
Ability to utilize multiple computer applications and operating system concurrently.
Ability to recognize customers' anger and attempt to defuse it.

Nice To Haves

Knowledge of medical terminology and health insurance terminology, preferred.
Front desk/central scheduling and/or registration experience, preferred.
Epic experience, preferred

Responsibilities

Use Endeavor Health protocol to verify patient selection.
Performs online eligibility and benefit checks for applicable payers as outlined in guidelines.
Enters data accurately into Epic in accordance with standards.
Calls the insurance company directly to obtain required eligibility and benefit information for all managed care, governmental and commercial payers, Verifies if pre-certification is required.
Process accounts according to performance standards - timing, volume and quality
Use NorthShore protocol to verify patient selection.
Utilize established protocols to register patient (e.g. select insurance and guarantor, verify/enter demographic information)
Provide instructions to patient (e.g. prep instructions related to procedure, location, co-pay)
Accesses Medicare LMRP software to determine if ABN (Advance Beneficiary Notice) is required.
Ascertain medical necessity requirements for visit utilizing NEBO Eligibility Software. If medical necessity check fails, contact physician for more appropriate diagnosis if available.
Generate and complete ABN when needed and contacted the ordering physician and patient as outlined in procedural guidelines to communicate and explain requirement.
For pre-registered patients, fax the ABN to the responsible check-in area (department or registration) for the service.
Document all activities in Epic appropriately.
Process accounts according to performance standards - timing, volume and quality
Contacts physician office or insurance company to check status of and / or obtain existing precertification number for ordered service.
Documents obtained information including certification number and number of days approved for inpatients into Epic.
If authorization is not obtained as required, contact physician office and department regarding cancellation of procedure.
If authorization is not obtained due to medical necessity, contact ordering physician's office and patient regarding waiver requirement.
Generate and forward waiver as needed to department for patient signature.
Follows standards for documenting cases and forwarding to Financial Counseling.
Identify if callers have an existing NorthShorConnect account. If not, introduce NorthShoreConnect and encourage patient use.
Utilize Epic to create NorthShoreConnect account for patients.
Apply HIPAA guidelines to all situations, as appropriate.
Follow all NorthShore protocols to ensure compliance with HIPAA.