Insurance Verifier

Job Summary

Utilizing the telephone and appropriate Internet applications, the Insurance Verifier is responsible for verifying benefits and eligibility for all insurances subscribed to by patient. Using independent judgment, this individual protects the facility by way of their knowledge of Fresno Surgical Hospitals contracted and non-contracted payors. Acts as liaison with patients, physician offices and internal departments.

Salary Range: $17.52 - $ 27.00

Reasonable Accommodation Statement

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Minimum Education and Work Experience

• High School Diploma or equivalent
• Previous billing experience preferred.

Required Skills

• Must be familiar with healthcare industry concepts, practices, and procedures.
• Thorough understanding of different insurance plans, government agencies, Medicare and Medicaid.
• Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
• Ability to provide exceptional customer service.
• Basic computer knowledge.
• Correct and safe operation of office equipment, i.e., copy machine, adding machine, fax.
• PC competency, working knowledge of Microsoft Office Products (Word/Excel)

Minimum Standards

• Mock Code Blue (min. 2 per year if applicable)
• PPD/TB Screen
• Annual Competencies
• Flu Vaccine
• License/Certifications
• Compliance Training

Essential Functions

• Billing Information/Procedures:
  • Consults with internal and external entities to obtain and/or verify billing information.
  • Ensures accounts are financially secure by review of benefits, authorization/pre-certification requirements, and estimated patient responsibility.
  • Establishes acceptable payment arrangements in accordance with Fresno Surgical Hospital policy.
  • Analyzes statements and letters to ensure patient billing accuracy prior to mailing.
  • Keeps abreast with insurance contracts to include billing procedures and rates.
    
• Insurance Benefits/Procedures:
  • Verifies insurance benefits and eligibility utilizing the Patients Scheduled by Surgery date report for assigned patient alpha; cases are verified a minimum of six (6) days prior to the procedure.
  • Monitors and addresses procedure add-on and cancellation e-mails.
  • Accurately updates Patient demographic information and ensures documentation standards are followed.
    
• Professional Interaction/Patients:
  • Acts as primary contact for internal and external entities assisting with insurance questions, i.e., benefits, covered vs. non-covered services, self-pay and patient estimation quotes based on out of pocket, deductible, coinsurance, etc.
  • Contacts patients and clearly relays benefit, eligibility and approximate patient responsibility when estimation is $250.00 or greater.
  • Promptly returns calls for messages received
    
• Admission/Receipts/Scheduling Documents:
  • Picks up the Admission and Scheduling department documents daily; reviews documents for updates, files and/or distributes documents as appropriate.
  • Provides Admitting department with receipts and/or consent forms (when appropriate) no later than 3:00pm for succeeding day scheduled cases.
    
• Multitasks/Duties:
  • Other duties as assigned.
  
  

Physical Demands

• Ability to Adjust Focus- (ability to adjust eye to bring an object into sharp focus)
• Close Vision- (clear vision at 20 inches or less)
• Lift up to 10 pounds- up to 1/3 of time
• Push/Pull- up to 1/3 of time
• Reach with hands and arms- up to 1/3 of time
• Sit- 2/3 and more of time
• Stand- up to 1/3 of time
• Stoop, kneel, crouch or crawl- up to 1/3 of time
• Talk or hear- 2/3 and more of time
• Use hands to finger, handle or feel- 2/3 and more of time
• Walk- up to 1/3 of time

Work Environment

• Body fluid exposure- No
• Fine Dexterity- Both (7 hours)
• Grasping: simple/light - Both (3-4 hours)
• Grasping: firm/heavy- Both (1-2 hours)
• Hearing- Ability to hear alarms on equipment
• Hearing- Ability to hear instructions from physician/department staff
• Repetitive use of foot control- Both (1-2 hours)
• Repetitive use of hands- Both (7 hours)
• Typical noise level- Moderate Noise

Fresno Surgical Hospital complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.