Pre-Registration/Insurance Verification Representative (Pre-Visit Services, Registration and Insurance Verification)

Position Title:
Pre-Registration/Insurance Verification Representative (Pre-Visit Services, Registration and Insurance Verification)

Department:
OUHP Pre-visit Services

Job Description:

General Description: Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts.

Essential Responsibilities: ?? Performs pre-registration and insurance verification within 24 hours of receipt of reservation/notification for both inpatient and outpatient services ?? Follows scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information therein ?? Contacts physician to resolve issues regarding prior authorization or referral forms ?? Assigns plans accurately ?? Performs electronic eligibility confirmation when applicable and document results ?? Researches Patient Visit History to ensure compliance with payor specific payment window rules ?? Completes Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module ?? Calculates patient cost share and be prepared to collect via phone or make payment arrangement ?? Contacts patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment ?? Receives and records payments from patient for services scheduled. ?? Utilizes appropriate communication system to facilitate communication with hospital gatekeeper ?? Performs insurance verification and pre-certification follow up for prior day??s walk in admissions/registrations and account status changes by assigned facility ?? Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre- existing, non-covered, and re-certification issues ?? Utilizes Meditech account notes and Collections System account notes as appropriate to cut and paste benefit and pre-authorization information and to document key information ?? Meets/exceeds performance expectations and completes work within the required time frames ?? Implements and follows system downtime procedures when necessary ?? Practices and adheres to the ??Code of Conduct?? philosophy and ??Mission and Value Statement??

General Responsibilities: ?? Other duties as assigned

Minimum Qualifications:

Education: High school diploma or GED required

Experience: At least three years of insurance verification experience preferred

License(s)/Certification(s)/Registration(s) Required: N/A

Knowledge, Skills and Abilities:
?? Communication - communicates clearly and concisely, verbally and in writing
?? Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
?? Interpersonal skills - able to work effectively with other employees, patients and external parties
?? PC skills - demonstrates proficiency in PC applications as required
?? Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
?? Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately

Current OU Health Employees - Please click HERE to login.

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.

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