Insurance Verifier I

The Insurance Verification Representative I is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Perform pre-registration and insurance verification for inpatient and outpatient services.

• Follow scripted benefits verification and pre-certification format in the EMR and document results.

• Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.

• Assign insurance plans accurately and perform electronic eligibility confirmation.

• Complete Medicare Secondary Payor Questionnaire as applicable.

• Calculate patient cost share and arrange payment or collection via phone.

• Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).

• Communicate with physicians and case managers to resolve authorization or referral issues.

• Document benefit and authorization information in the standard EMR screens and notes as needed.

• Implement system downtime procedures when necessary.

• Practice and adhere to the organization's Code of Conduct and Mission and Value Statement.

General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications

Education Requirements

• High School Diploma or GED required.

Experience Requirements

• 1 or more years of experience in hospital Patient Access required.

License/Certification/Registration Requirements

• None Required.

Knowledge/Skills/Abilities Requirements

• Verbal and written communication.

• Customer service orientation.

• Basic math and PC proficiency.

• Ability to work effectively with patients, staff, and external parties.