Insurance Verification Representative II - Central Insurance Verification Clinic Team

oumedicine; USA; Remote; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

PTO

401(k)

Medical & Dental plans

Zusammenfassung

OU Health in the United States is seeking an Insurance Verification Representative II within the Admitting department to manage pre-registration, insurance verification, and patient demographics updates, ensuring compliance with payor requirements and supporting revenue cycle accuracy.

This role serves as a lead, mentoring staff, addressing complex verification issues, and coordinating with clinicians and case managers to resolve authorizations while maintaining EMR documentation and process

Qualifikationen

• 3+ years of experience in hospital Patient Access.
• Demonstrated leadership and mentoring abilities.
• Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP) within 180 days.

Aufgaben

• 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 missing demographic information and collect cost share.
• Assign insurance plans and perform electronic eligibility confirmation.
• Research patient visit history to ensure payor-specific rule compliance (e.g., Medicare 72-hour rule).
• Communicate with physicians and case managers to resolve authorization or referral issues.
• Document benefit and authorization information in EMR; maintain documentation standards.

Kenntnisse

Advanced communication

Leadership

Analytical thinking

Mentoring

Ausbildung

High School Diploma or GED

Tools

EMR systems

Jobbeschreibung

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

• 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.

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.

Benefits

• 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.

OU Health is an equal opportunity employer.