Insurance Verifier

WE ARE NORTH SHORE MEDICAL CENTER!

Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Essential / stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
• Comprehensive Employee Benefits : Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

SUMMARY

This position is responsible for timely and accurate pre-registration, insurance verification, and upfront collection. The Insurance Verification Coordinator works to prevent avoidable denials through compliance with payer pre-certification and authorization requirements.

The employee must accurately interpret managed care contracts and correctly calculate patient portion.

DUTIES AND RESPONSIBILITIES

• Consistently supports and communicates the Mission, Vision, and Values of St. North Shore Medical Center.
• Follows the North Shore Medical Center Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed

to present or detect unauthorized disclosure of Protected Health Information (PHI).

• Upholds the Standards of Conduct and Corporate Compliance
• Consistently follows facility guidelines and procedures in performance.
• Retrieve reservation / notification of scheduled service or walk in patient roster from scheduling and / or registration system / reports.
• Performs pre-registration, insurance verification, precertification / authorization, deposit calculation, and telephone collection within 24 hours of receipts of reservation / notification for scheduled services and 48 hours prior to the date / time of the

patient's appointment (when scheduled with 72 hours of appointment).

• Performs pre-registration, insurance verification, and precertification / authorization same day for unscheduled / walk in registration.
• Follows insurance verification scripting to ensure the appropriate level of benefit and pre-certification / authorization detail is obtained.
• Performs pre-certification / authorization same day for account status changes (unit to unit and / or level of care).
• Records detailed benefit and pre-certification / authorization information in the appropriate electronic form at (registration system) to ensure availability for revenue cycle reference.
• Coordinates activities with physician offices to ensure compliance with pre-certification / authorization and / or referral form requirements so that facility authorization can be obtained without delay;

obtains fully compliant and authenticated order for services.

Utilizes payer websites and / or eligibility vendor to obtain real time eligibility and benefit detail printing and / or cut-n-pasting detail to

ensure availability for revenue cycle reference.

• Contacts patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to obtain missing demographic information, quote / collect patient cost share, and instruct patient when and where to present at time of appointment.
• Communicates with hospital case management as needed to ensure clinical detail is provided to the appropriate payer in a timely

manner.

Utilizes registration system notes to document important information related to verification pre-certification, and upfront

collection.

• Follows system downtime procedures when necessary.
• Assists in registering patients or admitting patients when needed.
• Completes annual education requirements.
• Promotes a culture of safety for patients and employees through proper identification, proper reporting, documentation and

prevention of medical errors in a non-punitive environment.

Research patient visit history to avoid account and / or medical record duplication and ensure compliance with Medicare Payment

Window Rules.

Completes Medicare Secondary Payer Questionnaire to determine primary payer.

Growth : Enhances patient experience by fostering a positive relationship with customers.

• Contributes to improving patient satisfaction results.
• Promotes stewardship of hospital resources while ensuring quality patient care.
• Calculates patient cost share and perform telephone collection prior to service in accordance with upfront collection policy and

procedure.

• Meets / exceeds performance standards / productivity and upfront collection goals.
• Assigns accurate and appropriately sequenced payer code / Insurance plans.

REQUIRED KNOWLEDGE & SKILLS :

• Medical terminology, Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) / International Classification of Diseases (ICD)-9 coding knowledge.
• Knowledge of medical terminology / anatomy.
• The ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines.
• Knowledge of Microsoft Office programs includes Excel, Word or similar programs.
• Ability to maintain composure during challenging interpersonal interactions.
• Active listening skills, including interpersonal skills and telephone communication.
• Organizational skills with attention to detail and follow-up.

EDUCATION / EXPERIENCE / LICENSURE / TECHNICAL / OTHER :

Education : High School Diploma or equivalent education / experience

Experience (Type & Length) : One year within a health care setting

Software / Hardware : Meditech