Patient Accounts Insurance Verification Specialist -- Central Scheduling -- Document Center Building

Job Summary

Oversees the process of Insurance Verification, identifying patient responsibility and estimates in regards to payments (co-pays, deductible and co-insurance), and that pre-authorizations are obtained prior to the appointment date. Also, completing Insurance notice of admission for inpatient admissions with proper documentation in the patient record.

Responsibilities

• Daily review of the patient encounters that appear on your assigned worklist to ensure that insurance verification has been completed..

• Uses telephone communication to payers for verification and notifications.

• Uses electronic portals and websites for verification and notifications.

• Identifies and documents patient responsibility and estimates in regards to payments (co-pays, deductible, and coinsurance).

• Daily review of the patient encounters that appear on your assigned work list to ensure that preauthorization has been completed and covered with appropriate range of dates.

• Completes the notice of admission process to payers to notify that the insured individual has been admitted to the facility.

• Accurately documents insurance information into the patient record.

• Completes documentation in the patient record to communicate to Case Management/Utilization Review of next steps to complete inpatient authorizations.

• Obtains ambulatory infusion pre-authorizations for CAMC Health Systems, Inc.

• Reviews faxed documentation from physician offices and payers to ensure preauthorization has been approved and that the documentation is accurate on the patient record.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)

The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.

Competency Statement

Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.

Common Duties and Responsibilities
(Essential duties common to all positions)

1. Maintain and document all applicable required education.
2. Demonstrate positive customer service and co-worker relations.
3. Comply with the company's attendance policy.
4. Participate in the continuous, quality improvement activities of the department and institution.
5. Perform work in a cost effective manner.
6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.
7. Perform work in alignment with the overall mission and strategic plan of the organization.
8. Follow organizational and departmental policies and procedures, as applicable.
9. Perform related duties as assigned.

Education

• High School Diploma or GED (Required) Experience: Knowledge of medical terminology and experience in insurance procedures in a health care setting required. Working knowledge of managed care environment, procedures, and criteria. Knowledge of CPT, HCPCS, and some knowledge of ICD-10 codes preferred. 1 year experience with insurance verification or preauthorization preferred Substitution: 2 years healthcare or similar work experience may substitute for experience requirement

Credentials

• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Document Center Building

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Lisa J. Craft lisa.craft@vandaliahealth.org