Summary/Objective:

Insurance Verification Representative reviews electronic eligibility response tasks daily. Updates patient insurance information to ensure accurate processing of claims. Accesses information through use of billing system and utilizes resources to determine eligibility and determine contracted status. Reviews claims halted or denied for insurance mastering corrections and refiles claims or processes balances to patient responsibility. Assists PFS Insurance Verification Representatives.

Essential Functions

• Answers calls in a professional and timely manner while assisting patients, clinic personnel and insurance carriers with accurate information to ensure patient receives exceptional customer service.
• Enters/Masters insurance information into the patient account system; received via patient calls, Internal clinic communications, and hospital information.
• Reviews and Updates Patient Insurance per Pre-Visit tasks generated in the patient account system to ensure the patient’s coverage is Active, HMO PCP Match, Contracted plan and mastered per the Managed Care Insurance Selection Grid.
• Reviews and Updates Patient Insurance per TES-Edits generated in the patient account system, allowing the claims to be processed to the appropriate insurance carrier per effective and termination dates.
• Reviews and Updates Patient Insurance per Rejection Tasks generated within the patient account system or Claim Logic program. Processes per established guidelines.
• Identify Hospital patients, master insurance information in the patient account system and update the documentation presented by Coding department

Required Education and Experience: High school graduate. One - two years medical business office experience or related field.

Preferred Education and Experience: Basic medical terminology. Familiarity with various types of insurance plans (HMO’s, PPO’s, etc.)

Additional Eligibility Qualifications: Excellent organizational and problem-solving skills. Aptitude to retain detailed information. Ability to be multi-task oriented, to prioritize and to maintain production standards. Accurate typing rate of 40 wpm. Ability to operate the following equipment: computer, copier, fax, and 10-key calculator. Possess advanced skills in using telephone as a primary instrument for communicating and are knowledgeable with telephone etiquette. Must be able to assess a situation and decide best course of action. Professional appearance and manner required.