Insurance Verifier

Employment Type

: Full-Time


: Miscellaneous

Providence St. Joseph Health is calling an Insurance Verifier to our location in Torrance, CA. We are seeking an Insurance Verifier who will be responsible for ensuring that all outlined client scheduled accounts are verified and accounts are completed accordingly and may include any non-scheduled procedures such as add-ons, direct admits and transfers. The insurance verifier is responsible for making the telephonic process as pleasant as possible for all patients and their families additionally responsible for communicating payment policies and providing patient education as it relates to insurance benefits. This position ensures coordination and communication between departments becoming a resource for the patient, physician, and facility. The insurance verifier must accurately collect and input patient information into the database to ensure accurate billing and complete medical record attainment. The insurance verifier functions includes preregistration, insurance selection, interpretation of insurance contracts, collaborating with Manage Care contracting on obtaining Letter of Agreements, gathering patient complex demographics, benefits collections, and authorizations for the CA region. This position is responsible for the day to day operations of the department that verifies various types of insurance benefits from simple office visits to very complex surgical and medical procedures, securing authorization, notification for Inpatient and Outpatient surgery and Inpatient admissions for account information for reimbursement. This position is also responsible for ensuring patient satisfaction as it relates to securing accounts prior to the patients arrival to the medical centers. Resolve complaints, using patient satisfaction data to improve processes and partnering with clinical departments served to ensure incoming referrals to Providence are maximized. Must maintain up-to-date knowledge and competency with numerous federal, state and other regulatory body compliance regulations and third party insurance plans. Complexity of this position is evidenced by the use of simple and complex medical terminology and insurance verification protocols. The insurance verifier displays professional interpersonal skills and presence when communicating with physicians, staff and the public; as the front-line customer service representative, upholds and exhibits the core values in all communication. It is essential that this information be documented timely and accurately. The incumbent performs all duties in a manner that promotes the Providence mission, values, and philosophy. In all aspects, the incumbent serves as a role model for the values and mission of the organization. In this position you will have the following responsibilities: * Contact with patients and providers and insurance, by telephone or in person, to interview them with courtesy Demonstrated service excellence to financial secure appointments and procedures for specialized services. * Courteously and professionally responding to multiple phone calls and requests that often occur simultaneously. * Completes pre-registration, verifying demographics and insurance eligibility and benefits * Collect co-payment when applicable. If patient unable to pay during preregistration call, inform them to bring the co-payment at the time of the appointment. * Refers patients for financial counseling or financial assistance (Charity), if applicable and based on individual organization policies and procedures. * Utilizes time management skills to ensure completion of daily processes. * Ensure patients are pre-registered in a timely manner, ensuring accounts are complete, compliant, and billable and do not require rework or intervention. * Identifying services and payers requiring authorization and ensuring required authorizations are in place. * Identifying services requiring a referral and ensuring it is in place. * Ensuring Motor Vehicle Accident, Workers Compensation or other Third Party Liability paperwork has been completed. * Process real time eligibility and work queues timely and accurately. * Collaborate with other departments regarding scheduling, resource or staffing conflicts. * Maintain current knowledge of and competency with numerous Federal, State and other regulatory body compliance regulations and third-party insurance plans. * Use multiple computer applications to establish accounts and obtain verification information. Ensure all computer system entries are completed accurately and timely. * Maintain accurate, clear, concise, and complete account notes and other relevant information. * Closely adhere to set verification standards and handle time standards. * Promote PH&S as a premier service organization by treating customers with compassion and respect. * Identify, resolve and escalate major issues and service failures that impede success. * Maintain confidentiality of all patient demographic, medical, and financial information, ensuring proper handling and disposal of confidential documents and adherence to HIPAA. * Comply with all applicable Federal, State, and local laws, regulations, and requirements as well as PH&S policies and procedures in all aspects of job performance. * Required to think independently and to identify and make complex decisions in a fast-paced environment. Required qualifications for this position include: * High School Diploma or GED equivalent. * A minimum of one (1) years' experience in customer service or healthcare registration. * Demonstrated outstanding customer service experience. * Clerical and computer experience. Preferred qualifications for this position include: * Some college level course work particularly Medical Terminology or Medical Assistance coursework. * Some college level course work. * Certified Healthcare Access Associate (CHAA) or Certified Revenue Cycle Specialist (CRCS). * Satisfactory completion of college level Medical Terminology or Medical Assistant course. * Previous registrar, pre-registration, insurance verification and third party payer experience. * Healthcare experience in a hospital or clinical setting, health insurance or medical office. About the department you will serve. One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence in revenue cycle systems and structures in support of our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. ORC's objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.


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