Insurance Verifier Mmcso

Under the general supervision of the Financial Clearance Center (FCC) Supervisor. Contacts insurance companies, physicians, and patients to ensure that accurate patient demographic and insurance information is collected, and that a financial clearance determination can be made. Informs patients of their rights, the Centegra Health System financial policies, and collects patient liabilities. Meets department staffing needs which include weekends and holidays.
Provides excellent customer service to all parties by responding to customer requests/ issues in a proactive and timely manner. Displays Centegra Service Excellence standards. Displays positive intra/ inter-departmental communication skills.
Daily responsibilities include:
Verifying eligibility and benefits using electronic and telephonic resources
Obtaining pre-certifications, authorizations, and referrals to ensure managed care compliance for necessary appointments
Fulfilling notification requirements for inpatient admits
Contacting patients to request and obtain monies due, including monies due from previous visits, and issuing receipts
Establishing payment plans for patients unable to pay monies due in full
Entering the information gathered into the computer system
Performing any other function deemed necessary to perform financial clearance
Applying critical thinking skills to identify and resolve problems proactively to maximize reimbursement
Exhausting all alternatives when attempting to make a financial clearance determination
Other responsibilities may include:
Working closely with various departments throughout the health system, including Scheduling / Pre-Registration, Financial Counseling, Registration, Billing, Clinical Staff, and the Payment Discrepancy Unit
Identifying and communicating insurance plan updates to CMS Billing Managers for input into the insurance master
Providing patient education concerning patient rights, regulatory requirements and financial policies
Exchanging necessary information with the physician offices, hospital, nursing homes, and other departments to insure a complete and accurate registration record
Preparing oral/ written communications including periodic status reports
Answering telephones, handling calls or directing calls to appropriate area. Performing other related clerical duties
Documenting notes in computer system regarding all conversations with patients, insurance company representatives, pre-certification notification representatives, and results of collection efforts
Performing other duties assigned by Supervisor
Read and write, perform arithmetic calculations, and possess excellent interviewing and communication skills. Type 60 wpm and possess computer literacy.
Hold high school diploma or equivalent required, some college courses preferred.
Have one year service-related experience required. Three years service-related experience preferred. Approximately one to two years experience registering / billing in a medical setting or insurance claims processing preferred. Medical terminology and/or insurance terminology preferred.
Strong interpersonal skills necessary in order to effectively communicate with all customers (patients, visitors, hospital staff and others).
Ability to handle, diffuse, and resolve difficult situations, including customer complaints.
Team oriented to support Centegra team members as needed.
Flexibility and resiliency to adapt to diverse patient dynamics.
Highly motivated and goal-oriented to meet performance requirements, including ability to handle multiple tasks simultaneously and to prioritize worklists appropriately.
Strong analytical skills to process admissions and appropriately calculate patient shares.
Self-motivated and strong organizational skills; ability to handle multiple tasks.
Physical ability to perform functional requirements as detailed.
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

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