St. Mary's Hospital

The Insurance Verification Specialist will be responsible for complex, high dollar services including surgical, observation and in-house services. This position has the ability to work proficiently in the multiple areas of verification: Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification or Scheduling and are responsible for obtaining and verifying accurate insurance information, benefit validation, authorization and preservice collections

Position requires 3 months working onsite and than is REMOTE thereafter with 1 week a month required onsite.

Financially clears patients for each visit type, admit type and area of service via current HIS (Health Information System). Collects and documents all required demographic and financial information. Appropriately activates registration and discharges in a timely fashion.  

Analyze patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order.  Applies recurring visit processing according to protocol.  

Verifies patient information with third party payers. Collects insurance referrals and documents within HIS. Communicates with patients and physician/offices regarding authorization/referral requirements. Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary. Escalates accounts appropriately in accordance with department Defer/Delay policy to manager. 

Screens outpatient visits for medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients. Provides cost estimates.  Collects and documents Medicare Questionnaire and obtains information from the patient if third party payers need to be billed (i.e., worker’s compensation, motor vehicle accidents and any other applicable payer).   

Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.  Ensures Meaningful Use requirements are met as appropriate.     

Financial Advocacy: Screens all patients self-pay & out of network patients using approved technology.  Provides information for follow up and referral to the RHM Medicaid Vendor and/or Benefit Advocate as appropriate. Initiates payment plans and obtains payment.  Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family.  Incorporates point of service (POS) collection processes into daily functions

 

Trinity Health’s Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health’s dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

To apply for this job please visit trinityhealth.wd1.myworkdayjobs.com.