Insurance Verification Representative I
Required skills
- EMR
- Medicare Secondary Payor Questionnaire
- patient cost share
- authorization
- referral
Role summary
The Insurance Verification Representative I is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. Key responsibilities include performing pre-registration and insurance verification for inpatient and outpatient services, documenting results in the EMR, contacting patients for demographic information and cost share collection, assigning insurance plans, performing electronic eligibility confirmation, and calculating patient cost share. The role also involves researching patient visit history for payor compliance, communicating with physicians and case managers to resolve authorization issues, and documenting benefit information.
Position Title:
Insurance Verification Representative IDepartment:
AdmittingJob Description:
The Insurance Verification Representative I is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation.
Essential Responsibilities
Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
Perform pre-registration and insurance verification for inpatient and outpatient services.
Follow scripted benefits verification and pre-certification format in the EMR and document results.
Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.
Assign insurance plans accurately and perform electronic eligibility confirmation.
Complete Medicare Secondary Payor Questionnaire as applicable.
Calculate patient cost share and arrange payment or collection via phone.
Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).
Communicate with physicians and case managers to resolve authorization or referral issues.
Document benefit and authorization information in the standard EMR screens and notes as needed.
Implement system downtime procedures when necessary.
Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.
General Responsibilities
Performs other duties as assigned.
Minimum Qualifications
Education Requirements
High School Diploma or GED required.
Experience Requirements
1 or more years of experience in hospital Patient Access required.
License/Certification/Registration Requirements
None Required.
Knowledge/Skills/Abilities Requirements
Verbal and written communication.
Customer service orientation.
Basic math and PC proficiency.
Ability to work effectively with patients, staff, and external parties.
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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.
Originally posted on Himalayas
