Job Summary:
The Lead Insurance Verifier is responsible for leading of the financial clearance team ensuring patients receiving services at our organization are financially cleared. This individual is responsible for obtaining timely and accurate authorizations for all hospital services where needed and to ensure that patents are contacted timely in regard to their financial responsibility (when applicable). The Lead Insurance Verifier will be responsible to perform other tasks as needed as assigned by Patient Access leadership
Responsibilities:
This position is responsible for the day to day operations of the MHRH verification department that verifies various types of insurance benefits from simple office visits to very complex surgical and medical procedures, securing authorization, notification for Inpatient and Outpatient surgery, diagnostic testing and Inpatient admissions for account information for reimbursement
Prepares written estimates per patient. Calculates estimated patient responsibility based on scheduled procedures and insurance allowable per managed care grid
This position ensures coordination and communication between departments becoming a resource for the patient, physician, and facility. Communicates with Doctors office staff any issues with patients such as difficulty reaching the patient or inability to make an acceptable Financial Arrangement
This position is also responsible for ensuring patient satisfaction as it relates to securing accounts prior to the patients arrival to the medical centers
It is essential that this information be documented timely and accurately
Reviews eligibility discrepancies
Ensure Admission Notification has been completed and verify insurance eligibility
Ensure Motor Vehicle Accident, Workers Compensation or other Third Party Liability paperwork has been completed
Maintain current knowledge of and competency with numerous Federal, State and other regulatory body compliance regulations and third-party insurance plans
Must be able to follow directions and to perform work according to department standards when no directions are given
Review reporting to identify missed authorizations which will be provided to the appropriate verifier or obtain the authorization/referral to ensure that it is obtained
Basic knowledge of patient accounting and insurance systems
Accountable for maintaining a close working relationship with team mates, point of service registrars, departmental staff, physicians offices
Communicates with all customers (patients, families, staff, physicians, vendors, etc) in a helpful and courteous manner while extending exemplary customer service
