The Insurance Verification Representatives is responsible for the timely verification of medical insurance benefits for both admission and pre-admission visits. General duties will be confirming eligibility; verifying specific benefit coverage, and ensures appropriate data (pre-certification, authorizations & tracking numbers) has been obtained and documented into the registration system to secure reimbursement.
This position requires the full understanding and active participation in fulfilling the mission of Long Beach Memorial Medical Center. It is expected that the employee demonstrate behavior consistent with the core values. The employee shall support Long Beach Memorial Medical Center’s strategic plan, the goals, and the direction of the performance improvement plan.
Processes timely verifications of medical insurance benefits for admissions and pre-admissions. Must make required notifications to health plans and IPA's of patient admissions to obtain authorizations timely to prevent claim denials.
Confirming eligibility; verifying specific benefit coverage’s and ensures appropriate data (pre-certification, authorizations & tracking numbers) has been obtained. Performs insurance eligibility timely and accurately. Must be able to comprehend and act upon information that is returned from Real Time Eligibility (RTE). Must be able to read and decipher health plan contracts that are loaded in OnBase and must be able to add and multiply correctly to determine the Real Time Eligibility (RTE) to manually calculate the patients benefits to enter into EPIC for those health plan contracts that are not loaded into EPIC.
Possess strong knowledge with Health Plans, Medicare, Medi-Cal, Managed Care Plans, and Third Party liability guidelines. To ensure correct reimbursement one must be able to identify the correct insurance plan code to assign accounts for commercial plans, Managed Medi-Cal plans, Managed Medicare plans and Workman’s Compensation plans.
Inputs accurate documentation into the registration system to secure reimbursement. Ensure that all verification documentation is complete and is scanned into EPIC timely. Enters notes into referral or auth/cert workflow by following the Admitting department Standard Work regarding patient benefits, out of pocket life time max on benefits and effective dates of insurance eligibility.
Monitors/manages system work queues ensuring immediate bill release. Responsible for monitoring assigned EPIC WQ's to maximize productivity by meeting the Admitting department weekly goals.
Interact in a positive and constructive manner and must deliver excellent customer service with patients, visitors, office staff and hospital staff members in order to ensure workflow effectiveness. Must maintain an effective and prfofessional working relationship with co-workers and others.
May cover in Admitting areas (Main, ED, L&D, MCH, etc…) and perform the registration job functions.