The Insurance Verifier/ Financial Counselor is responsible for determining patient liability based on benefits and advises patient of their liability prior to scheduled elective procedures notifies patient(s) of financial responsibility; collection arrangement are made prior to services rendered for all elective care. Verifies insurance eligibility, and benefits for emergent and urgent admissions, procedures or other services ensuring communication of patient responsibility to the patient or responsible party. Verifies and secures accurate patient demographic and insurance information, updating patient account information as needed. Assists patients in making arrangements as needed for patient responsibility by time of discharge for emergent or urgent services. Screens and refers patients for possible linkage to state, county or other government assistance programs as well as Charity or Discounts as per the facility Charity and Discount policies. The Insurance Verifier/ Financial Counselor works closely with Case Management in securing Medicaid/Medical treatment authorizations as needed. Maintains effective communication skills, including verbal, written and telephone. Proficient in mathematical skills. Responsibilities
Understands and interprets contracts, explains patient liability based on benefits. Notifies patient of financial responsibility as required by hospital protocol
Maintains patient accounts in an orderly manner. Identifies any missing information or other discrepancies in the patient account documentation received. Gives accurate details and makes corrections as needed. Provides corrected face-sheets for patients chart with nursing unit.
Follows up with patients/families employers, physicians, and insurance companies to resolve all eligibility problems, including Medicare, government programs, and refers to appropriate department for follow up
Refers appropriate accounts to Medi-Cal/Medicaid eligibility vendor, internal eligibility counselor or appropriate agency for review and possible financial linkage
Acts as liaison between the patients/families, Case Management Department, Insurance companies and other department staff members regarding any problems with financial responsibility
Arranges collection of unmet share of cost, deductibles, co-payments and surgery flat rate payments from patients/families prior to elective services or prior to discharge for urgent/emergent services.
Verifies insurance benefits on accounts within one business day following urgent/emergent admission; investigates and resolves any benefit/eligibility discrepancies within one business day of reviewing files.
Regularly reviews admission and outpatient lists for current business day and begin eligibility & verification processes when time permits, preparing for the next business day. Reviewing for any potential issues that may require urgent attention.
Assists others as required and permitted. Communicates work left incomplete, or unresolved problems.
Uses the appropriate vocabulary when conversing with patients, physicians, insurance companies or other department personnel.
Reviews and researches daily admissions for completeness, accuracy and payment resource.
Notifies appropriate departments and physician of inability of patient to pay account or link to assistance programs within 48 hours of admission.
Assists in monitoring patient accounts involving Medi-Cal for payment source in conjunction with Medi-Cal guidelines.
Notifies Social Service/Discharge planning and Utilization Review of Medi-Cal status immediately as changes occur.
Performs a DDE print out on all inpatients and outpatient surgery for all Medicare Accounts.
Performs other duties as assigned or required.QualificationsEDUCATION, EXPERIENCE, TRAINING
Knowledge of standard insurance companies and verification requirements.
Well versed in authorization processes for all payers
Ability to multi-task, prioritize needs to meet required timelines
Analytical and problem-solving skills
Customer Services experience required
High School Graduate or GED Equivalent Required (effective 4/1/14 for all new hires
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: [ Link removed ] - Click here to apply to Insurance Verifier/Financial Counselor
Complex Problem Solving