Insurance Verification Representative

High School Diploma/GED required
1 year pre-cert experience, including navigating websites for online benefit review, coding or medical assistant background required
2 years Revenue Cycle, collections, customer service or cash application preferred
1 year Medical and managed care contract terminology preferred
Medical Assistant preferred
Certified Coding Specialist (CCS) – American Health Information Management Association (AHIMA)

Review clinical documentation in charts for accuracy and to obtain information updates regarding the verification process
Obtain and communicate information on patients’ eligibility status with insurance companies to ensure proper coverage and payment for services
Use Payor website, verbal communication, and other information to determine eligibility, reinstatement, and termination of Healthcare coverage
Collaborate with other departments within the hospital to align interdepartmental functioning, goals, and expectations as related to insurance verification functions
Collect, analyze, and record all required demographic, insurance/financial, and clinical data necessary to verify patient information
Conduct follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly obtain authorizations
Document financial and pre-certification information according to defined process in a timely manner
Refer patients to Financial Counselors as needed to finalize payment for services
Request and coordinate financial verification and pre-certification as required to proceed with patient care; document financial and pre-certification information according to defined process

Preferred Associate’s Degree
2 years Revenue Cycle, collections, customer service or cash application preferred
1 year Medical and managed care contract terminology preferred
Medical Assistant preferred