Insurance Verification Associate

Healthcare Staffing; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

Genesis HealthCare System is seeking a Benefits Verification Specialist to verify medical benefits and obtain pre-certifications for diagnostic exams across multiple locations. The role includes coordinating patient care, managing insurance communications, and ensuring accurate registration and scheduling for prescheduled appointments.

Ideal candidates will have 2+ years in insurance verification, strong communication skills, and proficiency with MS Word/Excel, plus EPIC experience.

Qualifications

• High school graduate or equivalent.
• Knowledge of insurance verification, with two years experience verifying and obtaining medical pre-certification.
• Solid written and verbal communication skills.
• Strong computer experience, including MS Word and Excel, and experience using other office equipment.
• Demonstrated ability to prioritize and handle multiple tasks simultaneously.
• Ability to work with minimal supervision and effectively solve problems.
• Working knowledge of medical terminology.

Responsibilities

• Verify medical benefits for scheduled exams and obtain authorizations.
• Coordinate care for prescheduled diagnostic appointments within the imaging center.
• Handle correspondence regarding patient insurance, demographics, appointments, and financial information.
• Pre-register patients in an accurate and efficient manner.
• Collect patient co-pays, deductibles, bad debt, and outstanding balances when applicable.
• Provide good faith estimates to self-pay patients timely to comply with No Surprises Act.
• Collaborate with physician office staff to obtain necessary documentation for pre-authorizations.
• Demonstrate knowledge of EPIC and scanning of documents.

Skills

Insurance verification

Pre-certification

Customer service

Medical terminology

Problem solving

Multitasking

Communication skills

Education

High school diploma or equivalent

Tools

EPIC

Microsoft Word

Microsoft Excel

Job description

GENESIS HEALTHCARE SYSTEM

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always.

Position Details:

Work Shift: Varied Shift (United States of America) Scheduled Weekly Hours: 40 Department: GHS Registration Additional job details: This position will be a float position and will require some weekends and holidays, and will float between all Genesis locations.

Overview of Position:

Responsible for verifying benefits and/or obtaining pre-certification/pre-authorization for all exams scheduled at the facility. Assists with coordinating care for all patients with prescheduled diagnostic appointments within the imaging center including pre-screening and preparation instructions prior to and after patient arrival. Handles correspondence regarding patient insurance, authorization, demographics, appointments, and financial information as applicable. Handles all correspondence, maintains files, acts as a patient liaison, receptionist, screens telephone calls within department and compiles departmental monthly reports.

ESSENTIAL DUTIES

• Working knowledge of authorization criteria specific to both insurance payor and exam type.
• Working knowledge of retro authorization and appeals process and attempting to obtain when needed.
• Maintain an understanding of authorization standardization workflow.
• Ensures that patients have a physician order before tests are performed or at the time of scheduling.
• Understanding of the patient registration process including patient demographic, insurance benefits, and financial responsibility information.
• Collect patient co-payments, deductibles, bad debt, and outstanding balances when applicable.
• Manages multiple phone lines efficiently and with excellent customer service skills and telephone etiquette.
• Verifies all medical benefits for scheduled exams and communicates medical insurance coverage to the patient and/or legal guardian.
• Provide good faith estimates to self-pay patients timely to remain in compliance with the No Surprise Act.
• Inform all true self-pay patients of presumptive eligibility opportunities and financial counseling options available.
• Collaborate with the physician's office staff as appropriate to obtain the necessary documentation, including pre-authorizations for all diagnostic exams.
• Pre-register all patients in an accurate and efficient manner.
• Demonstrates understanding of medical diagnosis with correct spelling.
• Demonstrates complete understanding and ability to apply patient access policies and procedures.
• Demonstrates knowledge to scan appropriate documents and search for documents in EPIC.
• Demonstrates knowledge of insurance and authorization web portals.
• Demonstrates ability to analyze and evaluate any presented problems by utilizing critical thinking.
• Knowledge of electronic prior authorization process specific to Rhyme.
• Consistently coordinates work to achieve maximum productivity and efficiency during the assigned shift.
• Demonstrates a willingness to stay late, and work weekends or other shifts to accommodate department needs.

QUALIFICATIONS

• High school graduate or equivalent.
• Knowledge of insurance verification, with two years experience verifying and obtaining medical pre-certification.
• Solid written and verbal communication skills.
• Strong computer experience, including MS Word and Excel, and experience using other office equipment. Will be required to learn department-specific programs.
• Demonstrated ability to prioritize and handle multiple tasks simultaneously.
• Ability to work with minimal supervision and effectively solve problems.
• Working knowledge of medical terminology.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS

1. Living the Genesis Mission, Vision and Values

Performs work in a manner that is quality focused. Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect. Results oriented and focused on achievement of objectives. Acknowledges and responds to the diversity of people and the situation. Encourages peers (others) to be owners of change. Always makes the effort to anticipate and exceed customer needs and expectations. Possesses the ability to engage others with patience and understanding. Acts in a manner that creates positive first and lasting impressions. Demonstrates the ability to own issues until they are resolved.

2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)

Introduces self and role…connects with everyone. Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback. Asks for and anticipates needs and concerns of others. Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.). Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately. Responds to requests in an appropriate and timely manner. Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.

3. Promotes Patient and Employee Safety

Demonstrates safe patient handling (i.e. transfers, transport, care administration, nutrition, medication, etc.). Demonstrates safe materials handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.). Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment. Demonstrates Slips/Trips and Falls Awareness. Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Works in a noisy environment with continual interruptions. Must work at a computer terminal for 6-8 hours a day. Must apply clinical knowledge and have the ability to read, write and utilize a computer. May be required to periodically rotate shifts and regular days off. All system employees must be willing to work all shifts, extra hours, holidays and emergency shifts as required. May be required to work at different registration locations (FCN, FCS, HealthPlex etc.). Must be able to lift 10 pounds, and frequently lift and/or move 25 pounds. Employee has to be able to push and pull COW”S (Computer on Wheels).

Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job. Our mission is to provide compassionate, quality healthcare. Genesis HealthCare System is an integrated healthcare delivery system based in Zanesville, Ohio. The system includes a not-for-profit hospital, Genesis Hospital, in Zanesville, an extensive network of more than 300 physicians and multiple outpatient care centers throughout the region. Genesis is the largest healthcare provider in its six-county region of southeastern Ohio, which includes Muskingum, Morgan, Perry, Coshocton, Noble and Guernsey counties. Genesis provides a higher level of service than what is typically found in a community of its size including open-heart surgery, trauma care a Level II special care nursery, neurosurgery and comprehensive cancer services. This level of care has established Genesis as a primary referral center for much of the region. In addition to traditional hospital services, Genesis offers a broader range of services through its affiliated organizations, which serve as Genesis' partners to extend care far out into the community. Our steadfast commitment to delivering high quality, compassionate patient care is recognized throughout the country with numerous awards and accreditations. We are proud of our rich history of serving the community and vow to continue the tradition of healing and caring with compassion, trust, innovation and excellence.