Insurance Verifier at PIONEERS MEMORIAL HEALTHCARE DISTRICT – Brawley, California

SUMMARY:

The insurance verifier must have experience working with insurance companies and have extensive knowledge of different types of coverage and policies. Must have excellent multitasking skills, with the ability to work on many projects at once. Providing information to Patient Financial Services of possible collection problems and communicating regularly to Utilization. In addition, responsible for knowing and doing all aspects of the Patient Registration Clerk and Leaders job duties

ESSENTIAL FUNCTIONS:

1. Contacts insurance companies and employers to verify eligibility and benefits for all Inpatient/Observation admissions and high ticket ancillary incoming patients. Records information into the system and coordinates with the Financial Services department with problems with financial arrangements needed.
   1. Reports to review organizations upon admissions and or pre-admissions in timely manner for hospital notification.
   2. Reviews hospital admission records of patients to ascertain the types of coverage and reviews accounts for complete and accurate information, including documentation into Midas for Utilization Review.
   3. Performs verification, authorizations approvals for MRI, Nuclear Medicine, Cardiology, and radiology services. Coordinates with Physician Offices to obtain necessary authorization prior to upcoming visits.
   4. Practices patient confidentiality and security of patient health information. Provides feedback as to the quality, accuracy and timeliness of other departments related to the admission and billing process
2. In the absence of the Admission Manager and Registration Leaders, directs and monitors the activities of admitting representatives in all areas of the Admitting department.
3. Performs periodic internal reviews to ensure adherence to Hospital and department policies and procedures. This includes determining problem areas and seeking compliance and/or corrective action.
4. Provides in-service training and orientation to familiarize staff with various financial programs, changes in laws affecting eligibility or services, and other aspects of financial counseling.
5. Demonstrates an understanding of Admission Policies and Procedures in performing job duties and instructing patients and hospital personnel. Routinely uses Admissions Policy and Procedure manual and other reference materials.
6. Performs general clerical functions: answers telephone, types, compiles necessary reports and maintains filing systems for information needed to complete work within the department.

OTHER RESPONSIBILITIES:

1. Customer Service: Promotes a positive patient experience, interfacility as well towards interdepartmental relation in a caring environment.
2. Independent thinking to exercise own judgment in determining actions in urgent situations and maintaining control.
3. Addresses multiple problems on a concurrent basis; Sets priorities and delegates effectively; Organizes and prioritizes work to meet deadlines.
4. Makes independent decisions when circumstances warrant such action.
5. Demonstrates professionalism in appearance, phone presence, with visitors and co-workers; is highly motivated, organized and capable of working independently with a minimum of supervision.
6. Is accountable to the Manager for fulfilling the operational and administrative policies and procedures; all activities are to be consistent with the requirements of the government’s, accrediting agencies, and with the overall goals of Pioneers Memorial Healthcare District.
7. Makes recommendations for solutions and implements corrective procedures.
8. Is responsible for maintaining confidentiality of patients, services rendered and financial or demographic information.
9. Acts as a backup for all other insurance verification areas.
10. Performs similar job-related duties as assigned.
11. Updates insurance files and maintains current policy benefits for accuracy.
12. Maintains deposit files.

Other duties as assigned from time to time.

SUPERVISORY RESPONSIBILITIES:

None

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

1. High School graduate or equivalent education/work experience with three to five years’ experience in the health care field is required. Required Characteristics – At least three years in the Registration area.
2. Verbal abilities required in order to converse effectively with insurance companies and agencies. Clerical perception required to avoid and detect clerical errors of Hospital admitting records.
3. An air of professionalism is required to effectively work closely with patients and representatives, as well as the Medical Staff.
4. Understanding and ability to apply medical terminology.
5. Strong clerical background is necessary. This includes 10 key adding machine, typing, and computer. Knowledge of filing systems and copy machines.

LICENSES AND CERTIFICATIONS: None

AGE OF POPULATION SERVED:

Newborn  Infant/Pediatric  Adolescent  Adult  Geriatric  All X No Patient Care X

PHYSICAL REQUIREMENTS:

1. Sits, stands, bends, lifts, and moves intermittently during working hours.
2. Visual and hearing acuity pertinent to communicating with patients/families/visitors.