GENERAL SUMMARY OF DUTIES
– Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts.
SUPERVISOR –Pre-registration/Insurance Verification Team Leader or Manager
SUPERVISES – N/A
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
• Perform pre-registration and insurance verification within 24 hours of receipt of
reservation/notification for both inpatient and outpatient services
• Follow scripted benefits verification and pre-certification format in Meditech custom benefits screen
and record benefits and pre-certification information therein
• Contact physician to resolve issues regarding prior authorization or referral forms
• Assign Iplans accurately
• Perform electronic eligibility confirmation when applicable and document results
• Research Patient Visit History to ensure compliance with payor specific payment window rules
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement
• Contact patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment
• Receive and record payments from patient for services scheduled.
• Utilize appropriate communication system to facilitate communication with hospital gatekeeper
• Perform insurance verification and pre-certification follow up for prior day’s walk in admissions/registrations and account status changes by assigned facility
• Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
• Utilize Meditech account notes and Collections System account notes as appropriate to cut and paste benefit and pre-authorization information and to document key information
• Meets/exceeds performance expectations and completes work within the required time frames
• Implements and follows system downtime procedures when necessary
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
• Communication - communicates clearly and concisely, verbally and in writing
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Interpersonal skills - able to work effectively with other employees, patients and external parties
• PC skills - demonstrates proficiency in PC applications as required
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
• Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
Pre-registration Insurance Verification Rep.doc Page 2 Revised 09/21/09
AGE OF PATIENTS SERVED:
This position requires competence in assessment, treatment, and/or care for the age groups indicated. The staff member must be able to demonstrate the knowledge and skills necessary to provide care, based on physical, psycho/social, educational, safety, and related criteria, appropriate to the age for the patients served in his/her assigned service area. The skills and knowledge needed to provide such care may be gained through education, training or experience.
Age Groups: Birth - 1 year (infant), 1 - 11 years (pediatric), 12 - 16 years (preschooler), 17 - 64 years (adult), 65 – Life Span (geriatric)
• High school diploma or GED required
• At least three years of insurance verification experience preferred
OU Medicine is the collaboration among OU Medical Center, The Children's Hospital, OU Medical Center Edmond, OU Physicians, OU...