Insurance Verifier

AHMC Healthcare•Anaheim, CA

1d•$23 - $26

About The Position

The Insurance Verifier provides timely and accurate insurance verification by obtaining current eligibility, benefit coverage, authorizations, and tracking numbers needed to support reimbursement. The role identifies patient financial responsibilities and insurance or other third-party reimbursement resources, and applies knowledge of contracts—including per diem rates, case rates, and stop-loss provisions—to help ensure accurate, timely reimbursement. The position documents insurance and billing information in the financial or registration system, reviews account and registration accuracy, and follows up on reimbursement issues and missing authorizations. The Insurance Verifier works closely with patient service representatives, patient advocates, case management, supervisors, and other hospital staff to maintain effective workflow, review work for accuracy, and support patient registration. The employee is expected to represent AHMC-ARMC professionally, uphold its mission, values, and organizational expectations, and support its strategic and performance improvement goals. Duties also include infection-control practices, required education and training, performance improvement participation, and other assigned clerical or related responsibilities.

Requirements

Minimum of 3–5 years of admitting/registration and/or business office background.
Positive work ethic.
Excellent interpersonal skills.
Ability to communicate effectively.
Strong organizational skills.

Nice To Haves

High school graduate or GED equivalent preferred.
General knowledge of third-party payors, PPO, HMO, POS, EPO, workers' compensation, Medicare, Medi-Cal, and Cal-Optima preferred.
Knowledge of insurance authorization, tracking, and pre-certification preferred.
Bilingual in English and Spanish preferred.
Computer and typing skills preferred.
Medical terminology preferred.

Responsibilities

Apply infection-control policies and practices, including standard precautions, disease-specific isolation, appropriate sharps handling and disposal, and ensuring the sterility of supplies and equipment.
Meet population- and age-specific competencies applicable to the unit.
Attend department-specific education, training, inservices, staff meetings, and mandatory educational activities; submit required paperwork on time and document attendance or review of meeting minutes.
Participate in department performance improvement projects and monitoring, and apply performance improvement principles, including the PDSA model.
Understand hospital contracts and HMO, PPO, POS, EPO, and government payors, and interpret patient financial responsibility.
Verify insurance coverage and eligibility for inpatients, outpatients, and direct admissions in a timely manner.
Obtain required authorizations, pre-certifications, and tracking numbers for all patient types.
Report registrations to the appropriate pre-certification review company and medical group or IPA, as required.
Identify potential problems such as inpatient-versus-outpatient procedure issues, possible denials, low benefits, and non-covered services or procedures; analyze the need for follow-up and refer issues to Case Management, the Manager, Patient Advocates, or the Supervisor as required.
Interpret contract terms, including per diem rates, case rates, and stop-loss provisions, to support accurate and timely reimbursement.
Accurately document insurance coverage, authorization numbers, and billing data in the financial or registration system.
Maintain clear and concise reimbursement-status documentation on all accounts and notify the manager or supervisor about problem accounts.
Identify whether facility billing should be sent to the IPA or plan and verify the billing address.
Perform quality and completeness reviews of accounts and check for errors.
Review admissions and registrations for accuracy, including service code, patient type, diagnosis spelling, missing diagnoses, registration fields, and insurance payor code.
Work closely with patient advocates to discuss potential insurance or benefit issues.
Work with the supervisor to identify deficiencies and suggest process improvements.
Reconcile prior-day activity against census, surgery, and ancillary schedules to maintain workflow.
Reconcile accounts against registration reports.
Maintain effective working relationships with coworkers, case management, nurses, physicians, and other hospital staff.
Communicate professionally and courteously with coworkers and hospital staff, including using appropriate telephone etiquette during periods of pressure, conflict, or high call volume.
Manage upset or distressed patients, resolve issues within the role's control, and help patients feel cared for and calm and willing to follow procedures.
Organize workflow and follow up on missing authorization numbers.
Communicate effectively in written and verbal form.
Perform patient registration and explain and obtain admitting documents.
Perform assigned projects, clerical responsibilities, and other related duties as assigned.