- INSURANCE VERIFIER I

Position Overview

As part of the Behavioral Health Insurance Verifier, this role is responsible for financial clearance of all patients assigned to their work list/queue. This includes ongoing support for ancillary services, central scheduling, and outpatient registration for add-ons, STAT issues, or accounts in question. The role will have a close working relationship with billing to address denials and appeals as needed.

Key Responsibilities

• Runs daily work list assignments from designated EHR to ensure patients on assigned work list are financially cleared for services.
• Uses the EHR integrated eligibility system, including daily review of pre-registration errors, correcting alerts as close to real-time as possible.
• Responsible for insurance verification, including authorization, benefits, and eligibility on all patients within the assigned work list at least one week prior to arrival.
• Ensures necessary third-party authorizations are secured as deemed by payer in a timely and accurate manner.
• Collaborates with billing on denied claims and appeals to resolve discrepancies and expedite payment.
• Collaborates with ancillary departments and referring clinics to ensure correct services are ordered and authorized prior to the service date.
• Uses Payment Estimator or similar tool to determine cost of service and familiarity with contracted services/insurances.
• Contacts patients as necessary prior to the date of service to discuss their financial responsibility per their insurance guidelines.
• Familiar with regulatory compliance related to medical necessity and has working knowledge of CPT/ICD/HCPC codes.
• Enters all pertinent information into the EHR notes.
• Assists in Central Scheduling and/or another service line if needed, requiring familiarity with requirements of all ancillary service areas.
• Responds to patients, families, offices, by the end of the business day.
• Keeps abreast of insurance verification rules, regulations, and new requirements.
• Performs other duties as assigned.

Location

SHS · SHS SHS BH YOUTH

Schedule

Full Time, Days, 10:30 - 7:00pm