INSURANCE VERIFICATION REPRESENTATIVE - PATIENT ACCESS - PRN

Located in Franklin, Tennessee, Williamson Health is one of the South’s most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Williamson Health Medical Group locations, the Bone & Joint Institute and the Monroe Carell Junior Children’s Hospital Vanderbilt at Williamson Medical Center.  Williamson Health offers comprehensive in-patient and out-patient services. We have more than 825 providers representing over 70 medical specialties and sub-specialties. 

Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We’re committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.

Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being. 
o    Medical, Dental, Vision
o    PTO
o    Retirement Matching
o    Tuition reimbursement
o    Discount programs
o    FSA (Flexible Spending Accounts)
o    Identity Theft Protection
o    Legal Aid

Williamson Health is an equal-opportunity employer and a drug-free workplace.
 

 

Verifies insurance benefits and performs pre-certification on Surgical Day Care Patients, Observation Patients, Inpatients and Outpatient procedures, to achieve maximum reimbursement in a timely manner.  Works closely with other departments and referring physician offices and is professional in all communications.   

 

POSITION REQUIREMENTS

Formal Education/ Training:
High School diploma or equivalent

Workplace Experience:
At least three years clerical experience in a professional customer service oriented office environment
At least one year Insurance verification/pre-certification experience required
Interprets physician orders and understands radiology protocols

Equipment and Skills Training:
Meditech, Fax, Copier, time and attendance system, patient access software, cash management/posting, AllScripts, FormsFast, Education system, Label and armband printers, hand-held communication equipment, email.

Physical Environment:
Office in all areas pertinent to position

Physical Effort:
Able to communicate in English verbally and legibly
Prolonged sitting, consistent keyboard and terminal usage
Standing, walking, bending, 
Efficient verbal and written communication
Ability to work well under pressure, to function dependently and 

PERFORMANCE STANDARDS

1. Consistently is up to date with payer requirements and is knowledgeable of billing requirements/regulations.  Consistently and accurately completes insurance verification sheets after verifying insurance benefits/precertification requirements by using  Passport, insurance websites, insurance cards and contacting insurance company by phone for all direct admits, ER admits and scheduled procedures.  Scans completed document to patient’s account.  Completely reviews insurance information entered by scheduler or registrar and updates information accurately to insure timely reimbursement.
2. Consistently uses good customer service skills when contacting patients, or physician offices when benefits have terminated or insurance information is incomplete or not available upon registration.
3. Consistently reviews faxcert or AllScripts to obtain physician orders, clinical information, insurance information and contacts physician office when discrepancies or additional information is needed. 
4. Consistently reviews printer for add-on and divides work between co-workers to insure timely verification and authorization throughout the day.
5. Consistently obtains and verifies prior authorizations and compares to the physician orders to insure accuracy.  Obtains updated orders as needed.  Relays clinical information to insurance companies accurately.  Consistently follows-up on after hour and weekend patients/procedures for authorization/retro authorization in a timely manner.
6. Consistently communicates and assists (throughout the workday) other insurance verifiers with daily and future work.
7. Participates in departmental meetings/huddles/etc. and recommends improvement opportunities.  Performs other duties as assigned by Patient Registration director or manager and independently seeks out job duties during down time.
8. Consistently notifies the Medicaid counselor and financial counselor of self-pay patients or when patients insurance has terminated to make financial arrangements.
9. Understands and willingly adjusts working hours and job duties to accommodate patients and the department.  Recognizes the need for change in daily routine; willingly alters lunch/break schedule to accommodate patients waiting to register.
10. Communicates with all stakeholders when issues delay treatment due to pre-certification or verification requirements.
11. Consistently communicates and documents significant patient information to hospital departments and physician offices by outlook, BAR module and scheduling module in a professional manner. Acknowledges e-mails in a timely manner. 
12. Reports concerns requiring attention to supervisor or director.  Is a problems' solver that brings possible solutions with the concerns or problems.