Insurance Verification Rep

Insurance Verification Rep

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings.

This job is responsible for completing insurance verification of benefits, obtaining behavioral authorizations, completing pre-registration and registration as needed, answering questions via phone and email from front desk staff and patients. An incumbent conducts verification, authorization through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently.

Essential Function

• Applies a thorough understanding / interpretation of Verification of Benefits (VOB) to confirm patient eligibility
• Communicates effectively over the phone and through written correspondence with providers, clinical staff, clinic managers, and payers to obtain VOB, and behavioral authorizations.
• Applies understanding and knowledge of medical terminology, payer guidelines, CPT codes, ICD-10 codes to ensure appropriate behavioral authorizations are obtained
• Recognizes when additional assistance is needed to resolve complex issues and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and / or per the direction of management and in accordance with policies, procedures and other job aides.
• Works the claim edit work queues timely and efficiently to correctly resolve the error.
• Assists with unusual, complex or escalated issues as necessary.
• Accurately documents behavioral authorizations, VOB, and co-pay amounts.

From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters : being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.