Insurance Verification Representative - Penn Medicine at Home

About the role

Penn Medicine is dedicated to its tripartite mission of providing the highest level of patient care, conducting innovative research, and educating future leaders in medicine. Working for this leading academic medical center means collaboration with top clinical, technical, and business professionals across all disciplines. The Insurance Verification Representative will provide coordination and team support to the Core Unit staff within Penn Medicine at Home. The individual is primarily responsible for processing insurance information and faxing relevant data to Managed Care Companies, running assigned reports, entering authorizations into the database, and following up with Managed Care companies to secure reimbursement on services. Additionally, the representative will verify insurance eligibility on existing patients to ensure plan coverage is current and unchanged.

Responsibilities

• Works in collaboration with CORE nurses to assure timely communication of insurance authorization information to Managed Care Companies.
• Follows up with managed care companies to assure timely receipt of insurance authorizations.
• Enters insurance authorizations into the system as faxed back from companies.
• Organized, efficient, and timely processing of all concurrent Authorization Management information and requests.
• Validates insurance coverage on all existing patients on a weekly basis to ensure no change in coverage or carriers.
• Utilizes department processes and tools to manage the processing of clinical reviews.
• Works collaboratively with department nurses to assure streamlined workflow.
• Communicates to CORE unit manager, staff, or clinical team managers regarding missing documentation.
• Documents all contact with patients, families, and payers in the computer system.
• Prints and distributes reports as assigned to managers and department staff.
• Communicates disposition of authorizations as needed.
• Communicates and documents all patient financial risk and responsibility to the patient, billing coordinator, and clinical team in a timely fashion.

Qualifications

• High School Diploma or GED (required).
• 2+ years admissions or insurance experience in a home care and/or hospice setting.