Munson Healthcare Insurance Verifier in Traverse City, Michigan
This position is Monday-Friday from 8:30 a.m.-5:00 p.m.
SUMMARY: Support oncology services by performing various insurance related functions.
2 years formal education or equivalent experience, Associates degree preferred.
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 year of related experience in customer service, healthcare or business field required with an additional 1.5 years in healthcare or insurance industry for a total of 2.5 years experience.
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.
ARIA and ABO
Insurance Verification systems
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 Business Manager, Cowell Family Cancer Center.
Organizationally reports to the Business Manager, Cowell Family Cancer Center.
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.
Supports the Mission, Vision and Values of Munson Healthcare
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Meets expectations outlined in Commitment To My Co-workers, and supports unit action plans.
Uses effective customer service/interpersonal skills at all times.
Works under general guidance.
Able to establish priorities and meet tight deadlines with strong problem solving ability
Exercises a high degree of control over confidential medical information.
Inputs and updates all insurance information in appropriate screens.
Verifies eligibility of all insurances available on line or by phone.
Identifies primary and secondary insurance. Inputs insurance information in correct COB order.
Obtains claim numbers and verifies that claims are established for Workmen’s Comp and Auto Insurance.
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. Urgent patients: obtains pre-authorization guidelines and communicates information to proper departments. Assists Cancer Research dept. in this area.
Performs insurance verification, obtains pre- and retro- certification information for outpatient/inpatient activity. Communicates appropriate information to the PAS/Utilization Management teams as required. Follow up on all verification issues in a timely manner, and communicate information to proper departments.
Identifies and documents patient financial liability. Refers patients to Financial Counselors/Navigators to obtain financial assistance and /or payment arrangements when appropriate.
Responsible to keep current on billing requirements from third parties such as, Blue Cross/Blue Shield, Medicare, Medicaid, and all other health insurance carriers.
Responds to patients professionally in person and over the telephone. Responds effectively and in a customized manner to patients and families.
Solves problems and anticipate peak periods of patient traffic and/or volume in order to plan workload accordingly.
Documents patient messages/requests in EHR and forward to appropriate clinical staff/physician.
Submits medical records required by payers, for audits, and assists with appeals.
Serves as support to other clerical staff, including training and problem solving.
Works various reports.
Meets productivity and quality standards.
May be assigned specialized tasks, including reports, process/protocol development, or department specific projects.
May be assigned to provide support to outreach clinics, including travel and working at an alternate site.
Performs other duties and responsibilities as assigned.