SLEEP Insurance Verification Rep Full Time Days

Full Time IN OFFICE 40 hours/week

Required:   Knowledge of medical insurance terminology and ICD codes.

Preferred:  34 years of  healthcare related experience

The Insurance Verification Representative reflects the mission vision and values of NM adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.

The Insurance Verification Representative confirms accuracy of and verifies insurance benefits for nongovernment payers (managed care) on new patients for the Wheaton inpatient acute and subacute programs.

Responsibilities:

• Precertifies with insurance or obtains case management or insurance adjusters approval for planned services or procedures.
• Uses the predetermination process to determine coverage for procedures in question.
• Provides detailed information to admissions staff clinical referral liaisons case managers nursing staff and physicians when appropriate.
• Discusses financial responsibility with pending patients as needed.
• Obtains and coordinates preliminary case management authorization.
• Coordinates information from the patient physicians and office staff clinical referral liaisons and employers as needed to and complete the verification process.
• Obtains thirdparty precertification and concurrent review information and communicates to the admissions staff clinical referral liaisons case managers appropriate physician departments and payer representatives.
• Communicates any changes in patients clinical status to thirdparty payer to ensure authorization is current and accurate and provides notice of patient admission into the facility.
• Keeps insurance verification tracking log current and available to admissions staff and clinical referral liaisons with the most uptodate status of patients in the verification queue.
• Communicates situations projected to result in a significant noncovered balance to the department director.
• Communicates corrected information and acts as a resource to admissions staff clinical referral liaisons case managers and others regarding contract guidelines and precertification requirements.
• Notifies admissions staff clinical referral liaisons and department director when medical review is required.
• Reviews and analyzes financial information from third party payer systems and communicates that information to the business office and appropriate servicing department.
• Keeps uptodate on trends and issues that affect reimbursement.
• Performs verification/certification function using alternative processes in case of downtime or disaster.
• Tracks and records insurance denial trends and manages the appeal process on behalf of patients.
• Collects accurate financial data and enters into Meditech.
• Works with admissions staff clinical referral liaisons case managers and other departments ensuring financial data integrity is maintained and critical elements are reflected in the patient record.
• Maintains a strong customer focus while working collaboratively within a team to meet multiple demands patient needs and coverage.
• Maintains confidentiality of all information.
• Suggests quality improvement ideas and participates in education and improvement efforts.
• Provides communication to patients patient financial services and case managers on insurance findings.
• Contacts patients guarantor and business offices to inform of financial responsibility and attempts to coordinate financial arrangement.
• Produces projected benefit letters for patients and acts as a point person for counseling.
• Communicates benefit detail to admissions staff clinical referral liaisons and case managers to ensure notification and collection of copays deductibles and outstanding balances.
• Coordinates additional information requests as may be necessitated by third party administrators.

AA/EOE.

Qualifications :

Required:

• High School or Equivalent (GED).
• Knowledge of medical insurance terminology and ICD codes.
• Ability to understand and communicate financial information.
• Ability to work independently.
• Excellent communication skills.
• Strong customer service focus.
• Resourceful with problem solving.
• Wellorganized and efficient.
• Demonstrates proper telephone customer skills.
• Must be able to perform multiple tasks with composure and confidence.
• Ability to maintain composure under pressure.

Preferred:

• Three to four years of healthrelated experience.
• Associates or Bachelors degree.
• Highly proficient computer skills.

Additional Information :

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age sex race color religion national origin gender identity veteran status disability sexual orientation or any other protected status.

Remote Work :

No

Employment Type :

Fulltime