Patient Access Insurance Verification Rep

Insurance Eligibility Specialist

Contacts insurance payors to secure eligibility, benefits and authorizations for services rendered to ensure financial reimbursement for the facility.

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.

Collects deposits on co-pays, co-insurance, deductibles and out of pocket maximum and past due balances for patient and / or guarantor for anticipated services and admissions. Establishes payment arrangements and offers financial assistance as needed.

Ensures completion of financial documentation in accordance with TMCH's credit and collection policies.

Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.

Interacts with physicians and / or physicians' office staff to secure diagnosis, procedure details or authorization information.

Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments as needed.

Demonstrates knowledge of resources, staffing, instrumentation, and equipment specific to procedures to avoid scheduling conflicts as needed.

Communicates with departments / physicians for special requests, emergent cases, overbooking and add-ons.

Handles incoming telephone calls in appropriate service area; to service patients, physicians, physician office staff, and hospital personnel, if applicable.

Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records, as applicable.

Completes insurance processing; including account creation, insurance verification, notification, and authorization functions.

Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.

Reconciles daily cash drawer.

Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.

Performs related duties as assigned.

EDUCATION : High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.

EXPERIENCE : Preferred one (1) year of medical office and / or hospital experience to include healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and / or surgery.

LICENSURE OR CERTIFICATION : None required.

KNOWLEDGE, SKILLS AND ABILITIES :

• Knowledge of office management practices, including billing and scheduling within healthcare.
• Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
• Ability to write simple correspondence; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations.
• Ability to effectively present information and respond to inquiries or complaints from patients and / or their representatives and the general public.
• Ability to interpret and explain insurance benefits and patient financial responsibility.
• Ability to apply common sense understanding to carry out simple / detailed written or oral instructions.
• Applicants must have basic computer familiarity and experience and the ability to operate basic office equipment.