Insurance Verification Representative

Assist in providing access to services provided at the hospital. Knowledge of all tasks performed in the various Verification/Pre‐certification area is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. The position basic function is for the verification of eligibility/benefits information for the patient's visit, obtaining Pre‐cer/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy. Responsible for maintaining knowledge of HMO's,

PPO's, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers. Maintaining knowledge and adhering to third party payer contractual agreements minimizing the Hospital's financial risk for claim denials thus maximizing reimbursement for services rendered. Will be responsible for maintaining knowledge of the Financial Policy and deployment of practices used with Patient Access to resolve the patients' accounts.

Essential Function

Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account.

Process patient accounts and deploy established policies to resolve insurance issues with patient accounts with/without supervision i.e. conference calls with employer, payer and physician office staff

Initiate pre‐cert for in‐house patients when required, obtaining pre‐certification reference number, approved length of stay, and utilization review company contact person and telephone number.

Obtain authorization for scheduled patients and notify physician’s offices when the authorization is not on file with the patient’s insurance plan.

Document appropriate authorization numbers in HBOC approval field number 7 to appear on the UB for billing.

Notify hospital Case Managers on all in‐house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre‐certification.

Notify Kelsey‐Seybold Clinic utilization review department, by EMAIL, on all pending pre‐certs for scheduled and non scheduled patients.

Contact physician’s on scheduled patients, to notify them of authorization requirements and any possible financial holds.

Analyze reports (showing all previous accounts from the 5th day of the report) to ensure all “bedded” patient types have been verified and authorized

Analyze reports to ensure admission dates for patient type changes are accurate in order for the account to appear on the insurance verification report

Attend monthly staff meetings, in services, and Workshops as assigned.

Maintain and update reference notebooks on insurance companies, employers, pre‐certification requirements, etc to stay current on changes within the insurance industry

Disclosure summary
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.

Education and Experience Required:

• High School Diploma / GED
• Two (2) years relevant experience

• Epic experience a plus

Knowledge, Skills, Abilities, and Training:

• Basic math test
• Grammar test

• Epic experience a plus

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment, our new McNair Campus is designed around the human experience—modeled on evidence-based practices for the safety of patients, visitors, staff, and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care, research, and education. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.