Insurance Verification Representative II - Central Insurance Verification Clinic Team

OU Health•WFH State of Oklahoma, OK

About The Position

The Insurance Verification Representative II performs timely and accurate pre-registration, insurance verification, and patient demographic updates. The role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. It also serves as a departmental lead, performing advanced duties and assisting with staffing, quality assurance, reporting, and training.

Requirements

High school diploma or GED required.
At least 3 years of experience in hospital Patient Access required.
CRCR certification issued by HFMA or CHFP certification issued by HFMA required within 180 days of hire.
Advanced communication and leadership skills.
Strong analytical and problem-solving abilities.
Proficiency in EMR systems.
Ability to mentor and support team members.
High level of accuracy and attention to detail.

Responsibilities

Perform pre-registration and insurance verification for inpatient and outpatient services.
Follow scripted benefits verification and pre-certification formats in the EMR and document results.
Contact patients to confirm or obtain missing demographic information, quote or collect patient cost share, and provide appointment instructions.
Assign insurance plans accurately and perform electronic eligibility confirmation.
Complete the Medicare Secondary Payor Questionnaire as applicable.
Calculate patient cost share and arrange payment or collection by phone.
Research patient visit history to ensure compliance with payor-specific rules, such as the Medicare 72-hour rule.
Communicate with physicians and case managers to resolve authorization or referral issues.
Document benefit and authorization information in standard EMR screens and notes as needed.
Implement system downtime procedures when necessary.
Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.
Lead daily operations and assist staff with complex insurance verification issues.
Monitor and reconcile reports to ensure timely and accurate processing.
Support quality assurance processes and assist management with audits.
Train new staff and provide ongoing guidance to team members.
Serve as a point of contact for escalated issues with physicians, insurance companies, and case managers.
Ensure compliance with Medicare and other payor-specific rules and regulations.
Maintain documentation standards in the EMR.
Coordinate with hospital departments and facilitate communication across teams.
Assist with staffing coverage and workflow prioritization.
Perform special projects and other duties as assigned by management.
Perform other duties as assigned.