Insurance Verification Lead

1 month ago

Valhalla, United States Westchester Medical Center Full time

Job Summary: The Insurance Verification Lead is responsible for leading the financial clearance team at Westchester Medical Center, ensuring patients receiving services are financially cleared. This individual is responsible for obtaining timely and accurate authorizations for all hospital services where needed and to ensure that patients are contacted timely in regard to their financial responsibility. The Insurance Verification Lead will be responsible for performing other tasks as needed as assigned by Patient Access leadership.

Responsibilities:

  • This position is responsible for the day-to-day operations of the MHRH verification department, verifying various types of insurance benefits from simple office visits to complex surgical and medical procedures, securing authorization, notification for Inpatient and Outpatient surgery, diagnostic testing, and Inpatient admissions for account information for reimbursement.
  • Prepares written estimates per patient, calculating estimated patient responsibility based on scheduled procedures and insurance allowable per managed care grid.
  • This position ensures coordination and communication between departments, becoming a resource for the patient, physician, and facility. Communicates with Doctor's office staff any issues with patients, such as difficulty reaching the patient or inability to make an acceptable Financial Arrangement.
  • This position is also responsible for ensuring patient satisfaction as it relates to securing accounts prior to the patient's arrival to the medical centers.
  • It is essential that this information be documented timely and accurately.
  • Reviews eligibility discrepancies.
  • Ensures Admission Notification has been completed and verifies insurance eligibility.
  • Ensures Motor Vehicle Accident, Workers Compensation, or other Third Party Liability paperwork has been completed.
  • Maintains current knowledge of and competency with numerous Federal, State, and other regulatory body compliance regulations and third-party insurance plans.
  • Must be able to follow directions and to perform work according to department standards when no directions are given.
  • Reviews reporting to identify missed authorizations, which will be provided to the appropriate verifier or obtain the authorization/referral to ensure that it is obtained.
  • Basic knowledge of patient accounting and insurance systems.
  • Accountable for maintaining a close working relationship with team mates, point of service registrars, departmental staff, physician's offices.
  • Communicates with all customers (patients, families, staff, physicians, vendors, etc.) in a helpful and courteous manner while extending exemplary customer service.

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