Insurance Verification Specialist I

at NorthShore University Health System in Niles, Illinois, United States

Job Description

Position Highlights:
Position: Insurance Verification Specialist
Location: Niles, IL
Full Time
Hours: Monday-Friday, standard business hours

A Brief Overview:
Under the management of the Manager, Patient Access, the Pre-Certification Representative I is responsible to determine insurance eligibility and, as appropriate benefits, pre-authorization / pre-certification and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative I provides this service to ensure that our customers are provided a high quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative I helps to insure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimimized.

What you will do:
Use NorthShore protocol to verify patient selection
Performs online eligibility and benefit checks for applicable payers as outlined in guidelines.
Enters data accurately into Epic in accordance with standards.
Calls the insurance company directly to obtain required eligibility and benefit information for all managed care, governmental and commercial payers,
Verifies if pre-certification is required.
Process accounts according to performance standards - timing, volume and quality
Use NorthShore protocol to verify patient selection
Utilize established protocols to register patient (e.g. select insurance and guarantor, verify/enter demographic information)
Provide instructions to patient (e.g. prep instructions related to procedure, location, co-pay)
Accesses Medicare LMRP software to determine if ABN (Advance Beneficiary Notice) is required.
Ascertain medical necessity requirements for visit utilizing NEBO Eligibility Software.
If medical necessity check fails, contact physician for more appropriate diagnosis if available.
Generate and complete ABN when needed and contacted the ordering physician and patient as outlined in procedural guidelines to communicate and explain requirement.
For pre-registered patients, fax the ABN to the responsible check-in area (department or registration) for the service
Document all activities in Epic appropriately.
Process accounts according to performance standards - timing, volume and quality
Contacts physician office or insurance company to check status of and / or obtain existing precertification number for ordered service.
Documents obtained information including certification number and number of days approved for inpatients into Epic.
If authorization is not obtained as required, contact physician office and department regarding cancellation of procedure.
If authorization is not obtained due to medical necessity, contact ordering physician's office and patient regarding waiver requirement.
Generate and forward waiver as needed to department for patient signature
Follows standards for documenting cases and forwarding to Financial Counseling.
Identify if callers have an existing NorthShorConnect account
If not, introduce NorthShoreConnect and encourage patient use
Utilize Epic to create NorthShoreConnect account for patients
Apply HIPAA guidelines to all situations, as appropriate
Follow all NorthShore protocols to ensure compliance with HIPAA

What you will need:
High School Required
1 year of experience in a contact center, healthcare environment or customer service role.
Experience with referrals and pre-certification strongly preferred.
Strong attention to detail to accurately enter data and research and resolve questions
Ability to utilize multiple computer applications and operating system concurrently
Ability to recognize customers' anger and attempt to defuse it
Knowledge of medical terminology and health insurance terminology, preferred
Front desk/central scheduling and/or registration experience, preferred
Epic experience, preferred

Benefits:
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, and Vision options, including Domestic Partner Coverage
Tuition Reimbursement
Free Parking at designated locations
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight... For full info follow application link.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.