Insurance Verification Specialist
WestCare Health System - Sylva, NC

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GENERAL POSITION SUMMARY

The Insurance Verification Specialist is responsible for the accurate processing of all patient financial activity in the patient accounting system. This includes but is not limited to insurance verification/authorization, demographic information, financial arrangements, and exploring all avenues of reimbursement available. This position reports to the Admitting Supervisor and subsequently to the Director of Patient Financial Services.

The individual in the job title of Insurance Verification Specialist will also cross train and be able to function in the role of Patient Registrar on an as needed basis. The job summary for the Patient Registrar is below.

The Patient Registrar provides a first point-of-contact for WCHS patients and gathers pertinent patient data to facilitate services to the patient, as well as to facilitate receipt of payment to WCHS for the service/procedure. As a part of the registration process, the Patient Registrar generates registration forms and related items and assures that proper signatures are completed on these forms before the patient leaves the area. Responsibilities include obtaining required signatures various legal acknowledgements and performing the compliance check process on all Medicare patients with diagnostic tests ordered. This position is also responsible for obtaining diagnosis information when it is not available on the physician’s orders and is responsible for locating physician’s orders if missing. Collection of payments and accurate posting of payments is also a responsibility. The position is comprised of various other duties which often include escorting the patient to their room after completing admission forms, maintaining status changes, pre-registration for sleep studies, lab registrations and obtaining missing signatures/verifying insurance information on any inpatient admission that has come from another area of the hospital. In the event of a pre-surgical patient registration or other event that requires insurance pre-certification, the Registrar will obtain pre-certification and verify insurance benefit information.

The duties described herein are minimum standards and may be modified to meet the changing needs of the patient and MedWest Health System at any time.

QUALIFICATIONS:

A. Education and Training: High school graduate.

B. Experience: On-the-job training provided. The following experience is strongly desired:

1. 6 months to 1 year of experience with insurance benefits and medical terminology or coding. Consideration will also be given to those with experience in accounting related fields.

2. Computer literacy required. Experience, with demonstrated proficiency, in Microsoft Office products, especially Word and Excel, is desired.

3. M ust be able to demonstrate knowledge of medical insurance standards as related to obtaining pre-certification and verification of insurance benefits within initial 90 days of employment. Strong, proactive customer service skills are essential in this role. Must demonstrate the ability to successfully interact with customers in a variety of settings and situations. Must be accurate with data entry, be computer literate and have ability to multi-task. Must be a team player and interact well with other employees.

C. Affiliations: None required.

D. Customer Relations Skills:

Interacts in a positive way with co-workers, supervisors, and hospital staff. Interacts in a positive and courteous manner with physicians, patients, families and guest. Provides assistance and guidance as necessary. Communicates related information when appropriate and/or refers guests to source of needed information.

E. Communication Skills:

Communicates in a positive, courteous and helpful way. Follows the appropriate lines of communication in bringing problems of concern to appropriate department head and/or administration. Communicates and listens in an efficient manner.

F. Professionalism:

Attends annual mandatory in-services. Is knowledgeable of hospital programs and services. Maintains confidentiality of work-related information. Follows established hospital and /or departmental procedures for dress, personal maintaining a professional image and authority. Acknowledges project requests and follows through in an acceptable time frame. The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel.

PHYSICAL REQUIREMENTS:

Eye and hand coordination, manual dexterity for computer skills and visual acuity and hearing corrected to normal required. Extended periods of sitting required, with some walking, stooping and bending. Able to lift up to 20 lbs. and reach above shoulder height. Must be able to remain focused on the task at hand.

WORKING ENVIRONMENT:

Risk of exposure is minimal, but will have contact with patient while performing the registration process. Patient Registration is a high volume area and requires ability to adapt to a variety of situations.

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