IMH Insurance Verifier, Full Time - Days

UChicago Medicine•Harvey, IL

8d•Hybrid

About The Position

The Insurance Verifier, under the supervision of the Patient Access leadership, initiates the process for all scheduled elective outpatient services and inpatient admissions, including verification for observation cases and add-on procedures. This role is responsible for ensuring services are financially cleared prior to the date of service and securing necessary authorizations. For inpatient admissions, the verifier initiates notification within payer guidelines. The individual must stay updated on payer rules, state, and federal billing and collection regulations. Responsibilities also include clerical processing of assigned accounts, handling patient and third-party payer inquiries, and follow-up to ensure compliance with hospital and departmental collection policies for satisfactory disposition of all encounters.

Requirements

High school graduate or equivalent is required.
Requires two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third party, payor/regulatory agency requirements.
Requires good analytical and problem-solving ability

Nice To Haves

Some Medical Terminology
Excellent customer service skills
Typing required (minimum 25-30 wpm)
Experience in basic computer software programs (Microsoft Word, Excel, and Outlook)
Good written and verbal communication skills

Responsibilities

Responsible for obtaining daily work list assigned to the employee to begin financial clearance process prior to the date of service for elective scheduled services and within payer guidelines for the notification of admission. Obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation.
Handles all add-ons as assigned per work list, this includes STAT cases that need to be worked as priority per department policy
Secure all required clinical documentation needed to obtain the authorization
Maintain that all encounters needing verification is completed within 48 hours
Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained.
Handling phone calls from insurance companies, doctor offices and internal departments
Staying abreast of all insurance verification rules and regulations
Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement
Documents the hospital operating system with all pertinent information to support the claim if applicable. This includes the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.
Requires the ability to sufficiently understanding insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities
Run medical necessity as needed per payer
Collects out-of-pocket liabilities from patients upfront and applies, adjusts, and reconciles daily point- of-service cash reports
Communicates the estimated out of pocket liability for the visit.
Refers self-pay patients to Financial Counseling for self-pay screening to determine if the patient is qualified for additional financial assistance.
Refers patient accounts to financial counselors when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.
Performs other clerical duties as assigned by Manager, Patient Access and/or supervisor(s)
handle a variety of task with speed, and attention to detail and accuracy.