Job Summary / Purpose

Under general supervision, Insurance Verification Representative is responsible for obtaining authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to authorization and denial questions. Works closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.

Essential Key Job Responsibilities

1. Ensure authorizations are completed prior to patient treatment. 
2. Resolve any issues with coverage or eligibility and escalates complicated issues to manager. 
3. Tracks expiring authorizations and changed treatment plans to ensure the patient is covered for the entirety of their treatment. 
4. Coordinate with clinical staff to obtain charge information for all patients.
5. Assign appropriate authorization confirmations and dates to accurately support the need and documentation for each service.
6. Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
7. Works with registration, financial counseling, etc. to ensure the patient receives authorizations in a timely manner. 
8. Other duties as assigned by management.

Required Education for Staff Job Levels:

High School Graduate or equivalent

Preferred Education and Experience:

●       Bachelor degree in related field

●       2 – 4 years healthcare experience

Required Licensure and Certifications:

None

Required Minimum Knowledge, Skills and Abilities:

None

Welcome to Saint Joseph Hospital, a 433-bed hospital founded in 1877 by the Sisters of Charity of Nazareth as the first hospital in Lexington, Kentucky. Led by Sister Euphrasia Stafford, the mission to provide compassionate care to the underserved is still carried out today. Saint Joseph Hospital holds over two dozen national ranks and recognitions and is recognized as a 2024 Best Place to Work in Kentucky. 

Saint Joseph is part of CommonSpirit Health, a non-profit, Catholic health system dedicated to advancing health for all people. With approximately 175,000 team members and 25,000 physicians and advanced practice clinicians. 

Our commitment to serve the common good is delivered through the dedicated work of thousands of physicians, advanced practice clinicians, nurses, and staff; through clinical excellence delivered across a system of 140 hospitals and more than 2,200 care centers serving 24 states.