The Insurance Verifier provides a timely and accurate insurance verification; obtaining current eligibility, benefit coverage and authorizations to provide the necessary data to ensure reimbursement in a timely manner. This position identifies reimbursement resources for patient care and maximizing the effort to capture it. Identifies patient responsibilities, insurance reimbursement and other 3rd party reimbursement sources. Working knowledge of contracts with the ability to interpret per diem rates, case rates, stop loss, resulting in timely and accurate reimbursement. Performs outpatient pre-registration function, maintains effective working relations with coworkers, case management, outside companies, and visitors using guest relation techniques while professionally representing the visions and values of ARMC-AHMC Inc. Works closely with the patient service representatives, reviewing their work for accuracy and assisting them in their duties as needed.
This position requires the full understanding and active participation in fulfilling the mission of AHMC-Anaheim Regional Medical Center and AHMC Inc. It is expected that the employee demonstrate behavior consistent with the core values of ARMC and AHMC Inc... The employee shall support AHMC-Anaheim Regional Medical Center strategic plan, goals, and direction of the performance improvement plan. The employee will also be expected to support all organizational expectations including, but not limited to; Customer Service, Patient’s Rights, Confidentiality of Information, Environment of Care and ARMC and AHMC Inc. initiatives. Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.Contacts insurance companies via phone or website to secure authorization.Responsible to review all discharged managed care patients for evidence of authorization entry in the Authorization module.Obtains missing authorizations within 3 business days of patients discharge or in some cases within 7 days of admission.Responsible for checking bill hold weekly for pending authorizations.Assists with sending delinquent reviews and resending reviews not received by the Payors.Communicate effectively, build and maintain professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.Maintains analysis of authorization issues, by payer.Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.Follows established hospital policies and procedures regarding authorization processes.Other duties as assigned.
High school graduate or GED equivalent preferred