Lead Insurance Verification Specialist

Summary of Duties

Pay Range: $25.06/hr. to $35.08/hr. 

 

The Insurance Verification Specialist Lead supports the Patient Access Services Manager and Supervisor in strengthening structure, consistency, and accountability within daily operations. Works with the team to ensure accurate verification of all insurance to determine benefits allowed for in-patient and outpatient accounts, requiring an extensive knowledge of medical insurance. This will focus on identifying common denial trends, improving estimate accuracy, and ensuring correct coverage verification. Provides excellent customer service to patients and staff alike. Contributes to a positive work environment that promotes HMC values.

 

Job Duties & Responsibilities

 

1. Insurance and Financial Management. Representative duties and responsibilities include, but are not limited to:

• Verifies insurance, ensures prior authorizations have been obtained, obtains health and financial information of patients, updates patient accounts, refers accounts without insurance to Financial Counselor, notifying insurance companies of admissions for authorization.
• Reviews denial trends, identifies root causes, and reports findings not only for IVS but also for common errors that impact other departments.

 

2. Administrative Tasks. Representative duties and responsibilities include, but are not limited to:

• Reviewing medical records, providing insurance updates, maintaining equipment, maintaining procedures for insurance verification.

 

3. Telephone Triage and Communication. Representative duties and responsibilities include, but are not limited to:

• Answering phone calls, communicating patient financial responsibility, triaging patient needs, responding to and relaying messages, addressing case management concerns and complaints, and responding to inquiries.

 

4. Team Lead and Support. Representative duties and responsibilities include, but are not limited to:

• Identifies process errors, implements corrective action plans, and revises standards to support continuous process improvement.
• Assists with scheduling, keep up on insurance updates, provides relief coverage.
• Guides and trains team members, provides support and feedback to help them improve their skills and performance.
• Organizes and assigns daily tasks, ensures smooth workflow and efficient use of resources within the team. Notifies PAS Supervisor and/or Manager of staffing issues, call outs, and assists finding replacement staff coverage. 
• Addresses team issues and challenges and participates in facilitating solutions and escalates complex problems when necessary.
• Fosters open communications within the team and with other departments, facilitating collaboration and teamwork.

5. Performs other related duties and special projects, as assigned. 

 

Organizational Duties & Responsibilities

 

1. Compassion: Creates a welcoming environment of kindness, inclusivity, and responsiveness

• Treats others with courtesy and respect
• Seeks to understand others’ points of view
• Practices active listening
• Demonstrates cultural sensitivity and awareness of the differences, needs, and experiences of others.

2. Collaboration: Works with others to improve the health and wellness of Hillsboro & Washington County

• Participates as a team player
• Seeks opportunities to help others
• Considers the impact of personal behavior and decisions on others  
• Establishes and maintains effective relationships
• Adapts to changing circumstances in a positive manner

3. Excellence: Provides the highest quality of care and service

• Demonstrates commitment to performing job duties in an accurate, effective, safe, and service-oriented manner   
• Is action and results oriented 
• Seeks clarity or assistance when needed
• Responds effectively to feedback
• Participates in quality/continuous improvement activities
• Seeks opportunities to learn and build skills

4. Integrity: Demonstrates honesty, transparency, and accountability in every task and every interaction

• Safeguards confidential information
• Follows policies, procedures, conduct, and regulatory requirements 
• Communicates honestly and accurately
• Does not engage in gossip or misinformation
• Proactively reports quality/safety-related concerns
• Practices good stewardship with all organizational resources

Hiring Competencies

Minimum Qualifications

 

Education & Experience

• High school diploma or equivalent.
• Two (2) years’ experience in a health care setting specifically related to insurance verification or related work.
• Working knowledge of an EMR (Electronic Medical Record) and medical terminology.
• Medical billing and insurance terminology.

Required Knowledge, Skills, and Abilities

Knowledge of:

• Understanding of medical terminology, healthcare insurance, billing procedures, HIPAA regulations and confidentiality.
• Understanding of Electronic Health Records (EHR) Systems and office equipment and software (i.e. Microsoft Office Suite, scheduling software).

 

Skill in:

• Effective verbal and written communication, active listening, and interpersonal skills.
• Time management, prioritization, attention to detail, and multitasking.
• Excellent customer service skills including patience, empathy and problem-solving.
• Building strong relationships with patients, providers, staff, management.
• Proficient in computer software, including EHR systems.
• Leading and motivating a team, assigning tasks, and monitoring progress.

Ability to:

• Effectively use computer and software applications as needed to perform job duties.
• Maintain a professional appearance and demeanor.
• Educate and train staff members on processes and procedures.
• Work independently with minimal supervision.
• Collaborate effectively with healthcare team members.
• Adjust to changing priorities and work demands.

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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.

Salary : $25 - $35