POSITION SUMMARY

Pay range: $22.42/hr - $31.15/hr

The Insurance Verification Specialist is responsible for (but not limited to) verification of all insurance to determine actual benefits of in-patient and outpatient procedural and admitted accounts requiring an extensive knowledge on medical insurance. Notifies all insurance companies of outpatient and inpatient admissions for authorization, audits IP/OP procedural accounts, obtains prior authorizations for facility services that require such. Provides excellent customer service to patient and staff alike.

KEY RESPONSIBILITIES 

Performed majority of the time:

· Obtains needed insurance, health and financial information on patients coming into the hospital.

· Updates patient accounts as needed.

· Communicates to patient the patient’s financial responsibility as needed.

· Obtains and verifies insurance within department standard and ensures proper insurance authorization is obtained.

· Responds to voicemail within 24 hrs.

· Maintains equipment and reports equipment failures promptly to facilitate repairs.

· Refers accounts that do not have insurance to the Financial Counselor.

· Addresses Case Management concerns and complaints.

· Attends department meetings and provides insurance updates to the team.

· Reviews active medical records for presence of diagnosis and orders.

Performed occasionally but critical to successful performance of the job:

· Formulates and updates policies and procedures for insurance verification.

JOB SPECIFICATIONS

Education:

Required

· N/A

Preferred

· Associate degree with college accounting courses or equivalent accounting experience.

Experience:

Required

· Minimum one (1) year of hospital and insurance verification experience.

Preferred

· N/A

Licenses, Certifications and/or Registrations:

Required

· N/A

Preferred

· N/A

Job Related Skills, Abilities and Behaviors:

Required

· Computer experience.

· Demonstrates proper, professional appearance and personal conduct for the employee’s particular job.

· Insurance contracting knowledge preferred.

· Must have the ability to organize and prioritize large volumes of work, while supporting the needs and work load of your immediate team members and management.

· Experience working with highly confidential material/information.

· Medical billing and insurance terminology required.

· Medical terminology required.

· Requires self-discipline and sense of responsibility, as job requires strict attention to detail.

· Excellent customer service skills.

· Must be effective in verbal and written communication.

· Uses effective communication skills.

· Ability to read and understand physician’s orders.

· Utilizes electronic equipment and communication devices.

· Effectively uses online data bases throughout the insurance verification process.

· Assumes responsibility for maintaining competency in all areas where training was completed.

· Demonstrates confidentiality regarding patient and co-worker information according to PHI level of access.

· Prioritizes workload.

· Looks for ways to improve customer service.

· Formulates and uses effective working relationships with all healthcare team members, patients and significant others.

· Fosters positive work environment through teamwork and assistance.

· Demonstrates the ability to be self-disciplined, motivated and a self-starter.

Preferred

· Bilingual skills a plus.

*Please note: If applicable, any hybrid and/or remote work arrangements are based on business need and subject to periodic review between the employee, manager, and Human Resources. Proper scheduling notice will be provided if hybrid and/or remote work arrangements need to be updated or concluded.

Additional Posting Information

Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.