Insurance Verification Specialist

Job Code: IN4528
Full Time Days
8a-5p

ABOUT US

We are welcoming a new era in healthcare where achieving good health is just the beginning. At UVA Health Northern VA & Culpeper, we believe in caring for the whole person by getting to know – and making connections with – our patients. By combining the talent and expertise of our people, the breadth of capabilities across our system, and our commitment to helping our communities get better and stay healthy, we are improving the patient experience.

As a UVA Health Northern VA & Culpeper team member, you will have a voice in patient care decisions, support the most advanced medical technologies and feel a strong sense of satisfaction from making a difference in people’s lives every day.

JOB TYPE

Classification: Nonexempt

Supervises Positions: No

JOB SUMMARY

Coordinates insurance verification eligibility, pre-registrations, and authorizations for hospital services.

The following is a summary of the major essential functions of the job. The incumbent may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time: 

• Following established policies and procedures, verifies eligibility for patients and ensures all pre-authorizations, referrals, and pre-certifications are obtained as necessary by working closely with the physician offices, Utilization Review and Business Office Departments.
• Works closely with the collections department in identifying self-pay patients as well as repeated bad debtors and notifying Financial Counseling.
• Estimates patient financial liability for scheduled services and completes Financial Liability Worksheet as appropriate.
• Works closely with Utilization Review regarding insured patients to identify insurance coverage and limits. Assists uninsured patients pursuing financial assistance options.
• Coordinates appeals denied for no pre-authorization, assisting the patient, physician office and the insurance company.
• Assists Registrars when backlogged with patients in registration as necessary.
• Acts as back up to Schedulers.
• Perform other job-related duties as directed by the Supervisor.

Financial Acumen: Conducts financial analyses.

• Performs computations using advanced mathematical formulas or equations. 
• Develops and produces ad hoc financial reports for users throughout the organization. 
• Assists with the completion of financial surveys, month-end closing duties, and in the annual budgeting process. 

Quality Improvement: Assists in efforts to improve the quality of financial services. 

• Applies financial accounting standards to specific transactions/situations/scenarios. 
• Evaluates/Assesses/Complies with Internal Controls for financial systems.
• Assists with the coordination of the annual external financial audit. 

Collaboration: Works with staff across departments for internal and external financial reporting, accounting, and transactional research. 

• Works with study coordinators, regulatory team members, leaders, and finance to reconcile any discrepancies in data entered into the financial systems.
• Prepares financial reports, as directed by leaders and executives. 
• Provides financial quality assurance and reporting analysis for metrics across departments. 

The incumbent may be asked to perform additional duties as assigned.

QUALIFICATIONS

Education: High School Diploma or GED preferred.

Experience: Minimum of 2 years of related experience in admitting or business office. Refer to the Life Support Training Policy for additional details.

Licensure: N/A

Additional Skills/Requirements Required: Knowledge of basic medical terminology and ability to pass related basic spelling test. Ability to communicate both verbally and in writing. Ability to type 30 words per minute. Background of insurance knowledge is mandatory. Background/knowledge of government/state and patient assistance programs. Working knowledge of ICD-9 and CPT coding. Ability to comprehend insurance cards. Ability to deal directly with the public. Strong computer skills.

Additional Skills/Requirements Preferred: Proficiency in Windows and Microsoft Office preferred.

PHYSICAL DEMANDS

Physical Demand Code: 6A, Customer Service

Work Function/Activity: Sedentary to Light Physical Demand

The job requires frequent sitting and standing, occasional walking, and bending/stooping. Frequent repetitive arm, hand, and finger movements. Proficient communicative, auditory, and visual skills. Attention to detail and ability to write legibly. Ability to lift/push/pull up to 20 lbs. occasionally. This job description may not include all assigned duties, responsibilities, or aspects of the job described. It may be amended at any time at the sole discretion of UVA Health Northern VA & Culpeper.

OTHER

• May require the use of safety equipment, such as HEPA mask, for infection prevention: Yes
• On call responsibilities as directed: No
• Ability to travel between campus buildings, remote facilities, and out of town as needed: Yes