PFS Enterprise Insurance Verifier

Inova Health System; Virginia (MN); Remote; USD 45,000 - 60,000; Full time

Job summary

Inova Health System seeks a Patient Financial Services Enterprise Insurance Verifier to ensure patients' healthcare benefits are accurately verified. This role requires effective communication and knowledge of insurance processes. Offerings include competitive health benefits, retirement matching, and tuition assistance. Join a valued team improving community health.

Benefits

Medical, dental and vision coverage

Retirement matching

Tuition assistance

Mental health support

Flexible work schedules

Qualifications

• Three years of experience in hospital registration or physician billing.
• Strong knowledge of insurance authorization for elective procedures.
• Proficient with healthcare registration systems.

Responsibilities

• Ensure timely verification of healthcare benefits and authorizations.
• Serve as liaison between patients, physicians, and insurance.
• Maintain compliance with Medicare and regulatory guidelines.

Skills

Communication

Knowledge of insurance processes

Verifying healthcare benefits

Education

High School or GED

Tools

Epic

Job description

The Patient Financial Services (PFS) Enterprise Insurance Verifier is responsible for representing Inova Health System to physicians/patients while assisting both to gain access to services across the enterprise. Supports Inova, individual operating units, patient registration and patients/physicians by working timely to ensure patients' healthcare benefits are verified and cover the required procedures. Maintains current knowledge of and adhering to payer/regulatory guidelines for medical insurance claims processing and reimbursement. Understands and upholds the basic philosophies of the Revenue Cycle, Accounts Receivable and Patient Accounts. Communicates effectively and works cooperatively with others while showing respect for and an understanding of other registration disciplines.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health:offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement:Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance:offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support:offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance:offering paid time off, paid parental leave, and flexible work schedules
• Maintains productivity and accuracy standards as measured by work list completion, observation, and quality assurance.
• Serves as a Liaison between physicians, patients, and insurance to ensure all elective scheduled patients obtain authorizations.
• Ensures all precertification/authorizations are obtained timely. Enters amounts so payment arrangements can be made prior to the point of service. Performs verification of benefits, electronically or by telephone, according to department procedures/guidelines.
• Makes appropriate referrals to the self-pay team for County Medicaid, Non-County Medicaid, Emergency Medicaid, SLH, IHCTF, IFH, and/or MediCredit. Complies with department procedures and regulatory guidelines for Medicare Secondary payroll and ABN.
• Follows coordination of benefits and Medicare Secondary Payer guidelines to determine primary and secondary payer status. Follows department procedures for practice management documentation standards and updating accounts in Epic.
• Identifies and obtains required precertification, authorizations, and/or referrals while entering all information into the appropriate registration and billing system(s). Creates estimates through Carepricer for all scheduled elective patients.
• Completes the appropriate due diligence for each account when speaking with patients and follows Inova Health System's approved script as a guide regarding what to say and what not to say to patients.
• Identifies payment source and secures all information required to ensure a billable and collectible account while avoiding penalties, denials, and/or bad debt write-offs.

Minimum Qualifications:

• Education:High School or GED
• Experience: Three years of previous experience working in a hospital or healthcare facility in registration, patient accounts or physician billing office required; OR a combination of experience/education; (AA Degree = one year; Bachelor's Degree = two years)

Preferred Qualifications:

• Strong knowledge of insurance authorization and precertification processes for elective procedures, including commercial, Medicare, Medicaid.
• Proficient in Epic or comparable electronic health record and registration systems; experience with documentation and account updates per practice management standards.
• Strong understanding of payer portals, real-time eligibility tools, and benefit verification workflows, with ability to verify coverage both electronically and via phone.
• Effective communicator with proven experience serving as a liaison between patients, providers, and insurance companies to resolve coverage and authorization issues in a timely manner.
• Experience with financial counseling referrals for Medicaid and self-pay assistance programs, including coordination with internal or external eligibility vendors

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

About Us

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 25,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

Inova Health System is an Equal Opportunity employer. All qualified applicants will receiveconsideration for employment without regard to age, color, disability, gender identity orexpression, marital status, national or ethnic origin, political affiliation, pregnancy (includingchildbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation,veteran status, genetic information, or any other characteristics protected by law.