The Insurance Verification Specialist is responsible for verifying insurance coverage online, over the phone and via fax. This position is responsible for verifying if referrals and authorizations are required for scheduled services and providing this information either to the patient or other departments within the facility.
- Identifies and enters insurance demographics. Verifies specialty outpatient and inpatient insurance, both primary and secondary coverage (when applicable by service type), within set timeframes determined by Administrative Services Management. Verification includes obtaining and documenting covered and non-covered benefits, plan types, co-payments, co-insurance, out of pocket, and deductible amounts and determining contract and benefit eligibility.
- Verifies authorization standards for testing performed at National Jewish Health. Submits authorization requests for which clinical support can be faxed or for which clinical documentation is not required. Assists with notifying the clinical insurance authorization specialist when their support will be needed to complete authorizations requiring clinical support.
- Maintains communications with patients to keep them apprised of their insurance referral requirements and eligibility status. Acts as a problem solver with patients regarding their insurance plan.
- Notifies the Patient Financial Counseling Office of any significant gaps in coverage and/or high co-pays or deductibles prior to services being rendered for non-local patients.
- Maintains a thorough understanding of referral requirements, all major and local insurance plans and all ancillary procedures conducted by National Jewish,
- Meets productivity goals as established by Administrative Services and reports daily productivity data to supervisor.
- Maintains knowledge of medical terminology, all current procedural and diagnosis codes. Utilizes provided resources to obtain new codes as payers change and coding requirements are updated.
- Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health.
- Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
- Collaboration/Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
- Customer Focus: Ensuring that the customer perspective is a driving force behind business decisions and activities; crafting and implementing service practices that meet customers’ and own organization’s needs.
- Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
- Managing Work and Time/Project Management: Effectively managing one’s time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities; effectively creates and executes against project timelines based on priorities, resource availability, and other project requirements (i.e., budget); effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed.
- Peer Relationships: Interacts with others in a constructive, positive, and respectful manner, regardless of individual differences. Assists team members or co-workers in achieving personal goals and completing assignments.
Supervisory or Managerial Responsibility
- Be available to work as scheduled and report to work on time.
- Be willing to accept supervision and work well with others.
- Be well groomed, appropriately for your role and wear ID Badge visibly.
- Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
- Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
- Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures.
- Wears appropriate PPE as outlined by the infection control policies and procedures.
- Demonstrates compliance with all state, federal and all other regulatory agency requirements.
High school diploma or equivalent required. Associate’s degree preferred.
2 years experience in a healthcare setting working with insurance verifications/authorizations required. Outpatient hospital experience preferred.
Special Training, Certification or Licensure