Insurance Verification Representative - TMCOne

SUMMARY:

Prior to patient appointments, this position contacts patient’s insurance plans to confirm coverage and eligibility.  Ensures that registration is complete and accurate which includes demographic/biographical data as well as insurance information. These activities are to ensure reimbursement for provider services. 

ESSENTIAL FUNCTIONS :

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff ; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication. 

Obtains co-pay information, verify that services will be In/Out of Network, and updates system for anticipated services.

Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.

Interacts with physicians’ office staff to secure insurance information which may include referral or authorizations that may be required.

Performs patient registration activities to ensure accurate financial and biographical data, obtain documentation and properly enter into system records, as applicable. 

Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.

Provides self-pay patients with cost estimates on scheduled services prior to their appointments. 

Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.

EXPERIENCE :  Preferred six (6) months of medical office and/or hospital experience to include healthcare eligibility and benefit analysis or appointment scheduling experience.

LICENSURE OR CERTIFICATION : None required.

KNOWLEDGE, SKILLS AND ABILITIES :

• Knowledge of office management practices, including billing and scheduling within healthcare.
• Knowledge and understanding of insurance plans (i.e. HMO, POS, PPO etc.) and of government and commercial payors overall.
• Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
• Ability to write, document and make note of findings; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. 
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations. 
• Ability to effectively present information and respond to inquiries or complaints from clinic staff, coworkers and the general public.
• Ability to apply common sense understanding to carry out simple/detailed written or oral instructions. 
• Applicants must have basic computer familiarity and experience and the a bility to operate basic office equipment.