Insurance Verification Representative II - Central Insurance Verification Clinic Team

OU Health; United States; Remote; USD 42,000 - 65,000; Full time

Job summary

OU Health is seeking an Insurance Verification Representative II for the Central Insurance Verification Clinic Team to ensure accurate pre-registration and insurance verification for inpatients and outpatients. This role leads daily operations, trains staff, and resolves complex verification issues while maintaining compliance with payor requirements and documenting results in the EMR.

Strong communication and attention to detail are essential.

Qualifications

• 3+ years of hospital Patient Access experience.
• HFMA CRCR or CHFP certification required within 180 days of hire.
• High school diploma or GED required.

Responsibilities

• Perform pre-registration and insurance verification for inpatient and outpatient services.
• Follow scripted benefits verification and pre-certification format in the EMR and document results.
• Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.
• Assign insurance plans accurately and perform electronic eligibility confirmation.
• Calculate patient cost share and arrange payment or collection via phone.
• Lead daily operations and assist staff with complex insurance verification issues.
• Monitor and reconcile reports to ensure timely and accurate processing.
• Train new staff and provide ongoing guidance to team members.
• Serve as point of contact for escalated issues with physicians, insurance companies, and case managers.

Skills

Communication

Leadership

Analytical skills

EMR systems

Mentoring

Attention to detail

Education

High School Diploma or GED

Job description

Insurance Verification Representative II - Central Insurance Verification Clinic Team - Logo### Insurance Verification Representative II - Central Insurance Verification Clinic TeamApply: Virtual: Full time: Posted Today: R0069441## **Position Title:**Insurance Verification Representative II - Central Insurance Verification Clinic Team## **Department:**Admitting## **Job Description:**The Insurance Verification Representative II is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. This role serves as a lead within the department by performing advanced duties and assisting with staffing, quality assurance, reporting, and training.**Essential Responsibilities***Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.** Perform pre-registration and insurance verification for inpatient and outpatient services.* Follow scripted benefits verification and pre-certification format in the EMR and document results.* Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.* Assign insurance plans accurately and perform electronic eligibility confirmation.* Complete Medicare Secondary Payor Questionnaire as applicable.* Calculate patient cost share and arrange payment or collection via phone.* Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).* Communicate with physicians and case managers to resolve authorization or referral issues.* Document benefit and authorization information in the standard EMR screens and notes as needed.* Implement system downtime procedures when necessary.* Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.* Lead daily operations and assist staff with complex insurance verification issues.* Monitor and reconcile reports to ensure timely and accurate processing.* Support QA processes and assist management with audits.* Train new staff and provide ongoing guidance to team members.* Serve as point of contact for escalated issues with physicians, insurance companies, and case managers.* Ensure compliance with Medicare and other payor-specific rules and regulations.* Maintain documentation standards in the EMR.* Coordinate with hospital departments and facilitate communication across teams.* Assist with staffing coverage and workflow prioritization.* Perform special projects and other duties as assigned by management.**General Responsibilities*** Performs other duties as assigned.**Minimum Qualifications****Education Requirements*** High School Diploma or GED required.**Experience Requirements*** 3 or more years of experience in hospital Patient Access required.**License/Certification/Registration Requirements*** Certified Revenue Cycle Representative (CRCR) issued by the Healthcare Financial Management Association (HFMA) or Certified Healthcare Financial Professional (CHFP) issued by HFMA required within 180 days of hire.**Knowledge/Skills/Abilities Requirements*** Advanced communication and leadership skills.* Strong analytical and problem-solving abilities.* Proficiency in EMR systems.* Ability to mentor and support team members.* High level of accuracy and attention to detail.## **Current OU Health Employees - Please click** HERE **to login.**## **OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.**