Insurance Verification Representative - Full-Time

About the role

Humboldt Park Health is a community-based hospital deeply committed to serving the Humboldt Park community since 1894. With a focus on patient-centered care and quality of care, the hospital provides comprehensive healthcare services ranging from everyday care to critical treatments. The organization is dedicated to supporting its employees with various benefits and opportunities for growth.

Responsibilities

• Calls insurance companies or verifies online to obtain eligibility and benefit information for all inpatients admitted, outpatient surgeries, and future pre-admissions and outpatient test/procedures.
• Checks daily admission reports and surgical procedures to ensure all patients are accounted for.
• Verifies any required referrals, pre-authorizations, or pre-certifications, and obtains RQI or tracking numbers as needed to ensure reimbursement and minimize denials.
• Enters complete and accurate notes in HWS regarding benefits, pre-authorizations, UR review requirements, patient payment arrangements, and other pertinent information in a timely manner.
• Updates incorrect patient, guarantor, or insurance information in the Meditech Expanse Admissions module as necessary to minimize denial of claims and lost revenue.
• Contacts patients with group or private health insurance to explain benefits and payment options, and makes appropriate deposit and initial payment arrangements or provides information about the financial assistance program.
• Refers patients to the Financial Counselor if they express reluctance, difficulty, or concerns with timely payment of existing financial liabilities, or if their benefits are inadequate, terminated, or cannot be verified.
• Follows up with insured patients involving third-party liability (WC, personal injury, auto accidents, etc.), ensuring appropriate forms are completed and signed (as necessary), and scanned into HWS.
• Notifies relevant parties (Case Manager and/or Manager, Physician, etc.) when a Medicare inpatient has 5 or fewer available benefit days and/or patient's insurance is terminated, and notifies the director regarding admission and registration quality.
• Notifies the director regarding admission and registration quality and assists in identifying potential performance issues and training and educational opportunities.

Qualifications

• Prior experience with prior authorization for outpatient procedures is required.
• Prior experience with inpatient prior authorizations is highly preferred.