Insurance Verification Specialist

1 week ago

Longview, Texas, United States Christus Health Full time

Job Summary:

This position provides critical insurance verification functions for all scheduled and unscheduled patients at Christus Health. The Insurance Verification Specialist will contact insurance companies, utilize our electronic eligibility system, and analyze eligibility information to provide accurate estimates of patients' portions based on their insurance contracts. This role also involves pre-certifying patient visits with insurance companies when necessary and forwarding information to Case Management for clinical details.

Key Responsibilities:

  • Determine each patient's insurance eligibility and benefits by verifying with insurance companies, employers, or through our electronic system, adhering to departmental guidelines.
  • Identify priority accounts based on coverage, date of service, and expected dollar amount of services.
  • Verify all insurance for scheduled and unscheduled patients.
  • Obtain effective dates, correct mailing addresses, pre-certification telephone numbers, and document all information in the system.
  • Document unique coverage items, such as pre-existing conditions, limitations, and special attention to uninsured and credit risk accounts.
  • Calculate deductible amounts due and out-of-pocket amounts, including co-insurance and co-payment amounts.
  • Obtain pre-certification for the current visit from the insurance company and notify Case Management if clinical information is required for the pre-certification process.
  • Contact pre-certification companies to obtain pre-certification numbers for hospital visits.
  • Document pre-certification/reference numbers in the system.
  • Obtain authorization for Medicaid patients when necessary.
  • Refer accounts requiring clinical information to the Case Management Department.
  • Correct financial classes, insurance plans, and other errors to ensure accurate patient financial records.
  • Identify and correct incorrect insurance plans or financial classes in the system.
  • Delete incorrect or changed insurance plans from history in the system.
  • Correct Medicaid plans to reflect the appropriate plan.
  • If insurance is verified as terminated, document all information in the system and change accounts to self-pay.

Requirements:

  • High School Diploma or equivalent years of experience required.
  • 1 – 3 years of experience preferred.
  • None required for licenses, registrations, or certifications.

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