Munson Medical Center Insurance Verifier in Charlevoix, Michigan
ENTRY REQUIREMENTS Education: • Associates Degree or 2 years formal education or equivalent experience • Medical Terminology required or successful completion of medical terminology course within 90 days of hire. • Knowledge of current third-party payer reimbursement rules required. Work Experience: • Minimum of 1.5 years of related experience in healthcare. Keyboard – Computer Skills: • Advanced keyboard, mouse, computer and Microsoft Office skills. Must have knowledge and ability to learn, access and utilize 10+ of the computer programs listed below within 90 days of hire. Outlook Star Insurance Verification systems Smart Web Power Chart First Net 3M Coding Ontrac and related tools NextGen Cerner Other Entry Requirements: • Must possess exceptional oral and written communication skills. Ability to demonstrate effective communication with patients, Dr’s offices and technicians within hospital departments, and create accurate documentation with information gathered. Must be warm, friendly, and sensitive to the feelings and concerns of others. • Ability to demonstrate effective communication with Insurance companies to obtain, verify, and create accurate documentation with information gathered. • Ability to perform online insurance verification through the Internet. • Must demonstrate ability to adapt to change and keep up with continued advanced education requirements. • Work or education background, indicates ability to audit or verify written data for accuracy. ORGANIZATION: Under the general supervision of the Manager. Working relations with all ancillary department and co-workers. The ability to function responsibly in a minimally supervised work situation. Must be a self-starter and self-directed. Proven decision-making skills are required. SPECIFIC DUTIES 1. Supports the Mission, Vision and Values of Munson Healthcare 2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare. 3. Promotes personal and patient safety. 4. Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans. 5. Uses effective customer service/interpersonal skills at all times. 6. Works under general guidance. 7. Able to establish priorities and meet tight deadlines with strong problem solving ability 8. Exercises a high degree of control over confidential medical information. 9. Inputs and updates all insurance information in appropriate screens. 10. Verifies eligibility of all insurances available on line or by phone. 11. Identifies primary and secondary insurance. Inputs insurance information in correct COB order. 12. Obtains claim numbers and verifies that claims are established for Workmen’s Comp and Auto Insurance. 13. Identifies the need for pre-authorization information, makes decisions relating to insurance eligibility utilizing several on line systems available at MMC. Scheduled patients: Obtains and documents pre-authorization as appropriate for procedure. Emergent patients: obtains pre-authorization guidelines and communicates information to Utilization Management. 14. Follow up on all verification issues in a timely manner, and communicate information to proper departments regarding information obtained. 15. Responsible to keep current on billing requirements from third parties such as, Blue Cross/Blue Shield, Medicare, Medicaid, and all other health insurance carriers. 16. Performs insurance verification, obtains pre- and retro- certification information for all inpatient activity. Communicates appropriate information to the Utilization Management team as required. 17. Refers patients to Financial Counselors to obtain financial assistance and /or payment arrangements when appropriate. 18. Interprets and initiates problem solving, prioritizes work activity. 19. Keeps educational information, manuals and guides at team level updated and current. 20. Works various reports. 21. Meets productivity and quality standards. 22. Identifies and documents patient financial liability. 23. All other duties as assigned.