Insurance Verifier

About the role

The Insurance Verifier – Central Scheduling position at Saint Anthony Hospital is responsible for contacting insurance companies to secure accounts prior to services being rendered, obtaining authorization and referrals as required, and initiating and processing pre-admission and pre-registration functions.

Responsibilities

• Reviews pre-admission and pre-registration accounts daily and proactively contacts insurance payers and patients at least 72 hours before service.
• Ensures all required payer information is obtained, deposits are collected, and payment arrangements are established in accordance with organizational policies through timely, effective follow-up.
• Verifies insurance eligibility and benefits, uses payer and third-party systems to obtain authorizations, and coordinates with primary care providers as needed to secure required pre-certifications and authorizations.
• Reviews patient accounts to ensure all financial, insurance, and demographic information is complete and accurate, and documents updates in the hospital information system in accordance with established procedures.
• Interprets physician orders and collaborates with providers and clinical staff to ensure accurate documentation of diagnoses, procedures, and ancillary service requirements for patient scheduling and care coordination.
• Communicates financial obligations to patients, guarantors, and family members, including estimated patient responsibility for elective services.
• Reviews deductibles and other out-of-pocket costs before the date of service and accurately documents anticipated payments and payment arrangements.
• Discusses available payment options with patients, secures payment or payment arrangements, and refers eligible accounts to a Financial Counselor for financial assistance screening, including Medicaid (MANG) and Charity Care application processes.
• Maintains departmental logs and operational reports, including daily and weekly tracking of incoming, completed, and pending work.
• Documents all activities accurately in system notes and in assigned work queues.
• Completes patient registration in the hospital system by conducting telephone interviews to collect demographic, clinical, and financial information.
• Reviews data for accuracy, identifies potential financial risk, and collaborates with medical staff, financial counselors, and administrators as needed to resolve issues.

Requirements

• Demonstrated knowledge of billing, collections, and cash application processes, including issue identification and resolution.
• Working knowledge of healthcare reimbursement and revenue cycle operations.
• Experience using healthcare systems that support patient access and patient financial services functions.
• Minimum of one year of customer service experience; healthcare experience preferred.
• Excellent written and verbal communication skills with the ability to interact effectively across all levels of the organization.
• Demonstrated proficiency in electronic data entry with high accuracy.