Shift: Monday-Friday 8:00 AM - 12:00 PM

The Insurance Verification Specialist will verify patient information and confirm all insurance payer plans present on the account are up to date. If no insurance is present on the account, will research EPIC history for recent visit payer information. Will utilize May require contact with physician practice or patient to obtain form of coverage. Escalates for approval as appropriate to avoid patient delays in service. Specialist responds to questions from patients, clerical staff and insurance companies professionally. Updates account and maintains accuracy and confidentiality.
Maintain established productivity benchmarks and meets goals in a fast-paced environment. Other duties as assigned.

Core Responsibilities and Essential Functions:

Quality/ Safety

• Prior to a patient’s first visit, verify insurance coverage and benefits including co-payments and deductibles and OOP Max.
• Verify insurance coverage and benefits on a daily basis through Recipient Eligibility Verifications Systems and various payor websites and/or via telephone.
• Assist in Prior Authorizations, verify the accuracy of demographic and payor information. Notify admissions, scheduling and other related departments regarding concerns and corrections.
• Works in conjunction with Prior Authorization specialist to obtain initial and ongoing authorizations for outpatient visits, maintain tracking system, notify providers when continued authorizations are due and reapply as required. Follow up with insurance carriers to make sure that authorizations have been completed.
• Receive Explanation of Benefits and Authorizations and enter into the system as required.
• Keep current on new policies and procedures of third-party payors, hospital procedures and any insurance updates in order to educate providers and staff.
• Comply with departmental and organizational policies/procedures including but not limited to, dress code, telephones, cell phones, and computers.
• Perform other work-related duties as requested/directed by management.
• Observes work hours and provides proper notice of absences, tardiness work schedule changes.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the public. Demonstrates ability to tactfully handle difficult situations.
• Presents a well-groomed and professional image.
• Attends select departmental meetings at the request of WHS Management.
• Performs other duties as assigned.
• May work in the work queues to resolve insurance verification or coverage edits 20% Customer Service
• Greets all guest with a positive and professional attitude.
• Receives patients’ valuables for safekeeping in the hospital safe.
• Answers incoming phone calls and follows through with requests made.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the general public. Demonstrates ability to tactfully handle difficult situations.
• Presents a well-groomed and professional image in coordination with dept/ hospital dress codes.
• Expected Performance, Behaviors and Results:
• The “WellStar Experience” (Must demonstrate a commitment to Service Excellence by):
• Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.
• Valuing patients and family members as partners in their care.
• Having world-class processes in place.
• Delivering high-touch care that is reliable, responsive and coordinated.
• Focusing on constant innovation and creating improvements.
• Celebrating our diversity with sensitivity and understanding.
• Embracing the idea that we are all owners of our health system. 20% Budget/Financial
• Attempts to collect the estimated self-pay balance of all inpatient, outpatient and ER accounts, at the earliest possible collection control point.
• Monitors in-house accounts and attempts to make financial arrangements with guarantors for payment of their self-pay balances in full and prior to discharge.
• Completes financial evaluation forms to document guarantors' income, expenses, assets and liabilities.
• Identifies those patients without adequate insurance coverage. Makes personal contact with patient or guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (namely Medicaid).
• Maintains a list of health care financial assistance programs and the eligibility requirements for each program. Refers patients/guarantors to sources of outside funding assistance, as needed.
• Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.
• Contacts scheduled patients at home to obtain pre-admission information, explain financial policies, estimate self-pay balances, and obtain a promise to pay on or before admission/registration.
• Interviews all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.
• Documents concise and understandable notes regarding all self-pay account collection activity, as well as each patient or guarantor interaction. Documents all efforts to collect patient account balances, other self-pay collection activities and referrals to Medicaid.
• Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
• Verifies insurance coverage and benefits.
• Exceeds monthly quota on a consistent basis. Formally reports results of self-pay collection activity to direct supervisor, on a daily basis or according to policy. Provides feedback to PAS management concerning self-pay collection and data integrity issues.
• Responsible for completion of appropriate error/issues in Work Queues.
• Identifies and resolves Payor Denials as indicated. 30% General
• Observes work hours and provides proper notice of absences, tardies work schedule changes.
• Attends select departmental meetings at the request of WHS Management.
• Completes monthly, quarterly, and annual mandatory training as required.
• Performs other duties as assigned.
• PAS II Team members serve as preceptors and mentors and as such must:
• Maintain a 98% based on individual QA audit /or as reported by Epic (min. of 10 accounts) registration accuracy rate or higher in the past 12 months.
• Maintain minimum productivity requirements.
• Has no corrective disciplinary action during the past twelve (12) months.
• Willing and able to function as a preceptor in the orientation of new patient access personnel and students.
• Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board. 30%

Required Minimum Education:

High school diploma High School Diploma (HSD) Required or
GED Required and
Associate's Degree Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.