Insurance Verification Rep PD

Title:Insurance Verification Rep

Location:Long Beach

Department:Admitting

Status:Per Diem/Onsite

Shift:Days (8hr shifts)

Pay Rate: $23/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Insurance Verification Representatives is responsible for the timely verification of medical insurance benefits for both admission and pre-admission visits. General duties will be confirming eligibility; verifying specific benefit coverage, and ensuring appropriate data (pre-certification, authorizations & tracking numbers) has been obtained and documented into the registration system to secure reimbursement.

This position requires full understanding and active participation in fulfilling the mission of Long Beach Memorial Medical Center. It is expected that the employee demonstrates behavior consistent with the core values. The employee shall support Long Beach Memorial Medical Center's strategic plan, the goals, and the direction of the performance improvement plan.

Essential Job Functions and Outcomes

1. Processes timely verifications of medical insurance benefits for admissions and pre-admissions. Must make required notifications to health plans and IPA's of patient admissions to obtain authorizations timely to prevent claim denials.
2. Confirming eligibility; verifying specific benefit coverage's and ensures appropriate data (pre-certification, authorizations & tracking numbers) has been obtained. Performs insurance eligibility timely and accurately. Must be able to comprehend and act upon information that is returned from Real Time Eligibility (RTE). Must be able to read and decipher health plan contracts that are loaded in OnBase and must be able to add and multiply correctly to determine the Real Time Eligibility (RTE) to manually calculate the patients benefits to enter into EPIC for those health plan contracts that are not loaded into EPIC.
3. Create patient estimates accurately and timely. Notifies patient of estimate amount via phone and mailed letter. Responsible for computing patient estimates and advises patients of their financial responsibility: including deposits, co-pays, deductibles, estimate's and co-insurance timely and accurately.
4. Possess strong knowledge with Health Plans, Medicare, Medi-Cal, Managed Care Plans, and Third Party liability guidelines. To ensure correct reimbursement one must be able to identify the correct insurance plan code to assign accounts for commercial plans, Managed Medi-Cal plans, Managed Medicare plans and Workman's Compensation plans.
5. Inputs accurate documentation into the registration system to secure reimbursement. Ensure that all verification documentation is complete and is scanned into EPIC timely. Enters notes into referral or auth/cert workflow by following the Admitting department Standard Work regarding patient benefits, out of pocket life time max on benefits and effective dates of insurance eligibility.
6. Monitors/manages system work queues ensuring immediate bill release. Responsible for monitoring assigned EPIC WQ's to maximize productivity by meeting the Admitting department weekly goals.
7. Be at work and be on time. Must adhere to the MHS Time and Attendance policy, clocks "in" and "out" of MTM accurately with minimal manual clocking requests for each scheduled shift and must sign off on MTM by the end of each pay period.
8. Follow company policies, procedures and directives. Must adhere to all MHS policies and procedures and must adhere to all Admitting department directives as communicated by the Admitting Management team.
9. Interact in a positive and constructive manner and must deliver excellent customer service with patients, visitors, office staff and hospital staff members in order to ensure workflow effectiveness. Must maintain an effective and prfofessional working relationship with co-workers and others.
10. Prioritize and multi-task. Must posess the ability to multi-task and perform multiple duties at a time due to the high patient volume for the hospital.
11. May cover in Admitting areas (Main, ED, L&D, MCH, etc...) and perform the registration job functions.
12. Participates in department specific performance improvement plan (IE: education/training, staff meetings, projects, Gallup, Simply Better and Service excellence, etc.).
13. Performs other duties as assigned.

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities.Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out ourMemorialCare Benefitsfor more information about our Benefits and Rewards.

Minimum Requirements

Minimum of 5 years admitting/registration/insurance verification or equivalent healthcare experience required.
Knowledge of insurance and payors required.
Ability to communicate effectively verbally and written.
Must have strong customer service and computer skills.

Education

High school graduate required.
Medical/healthcare related courses preferred.
Bilingual preferred.