Insurance Verifier

Overview

The Insurance Verifier provides a timely and accurate insurance verification; obtaining current eligibility, benefit coverage and authorizations to provide the necessary data to ensure reimbursement in a timely manner. This position identifies reimbursement resources for patient care and maximizing the effort to capture it. Identifies patient responsibilities, insurance reimbursement and other 3rd party reimbursement sources. Working knowledge of contracts with the ability to interpret per diem rates, case rates, stop loss, resulting in timely and accurate reimbursement. Performs outpatient pre-registration function, maintains effective working relations with coworkers, case management, outside companies, and visitors using guest relation techniques while professionally representing the visions and values of WHMC-AHMC Inc. Works closely with the patient service representatives, reviewing their work for accuracy and assisting them in their duties as needed.

Responsibilities

This position requires the full understanding and active participation in fulfilling the mission of WHMC- Whittier Hospital Medical Center and AHMC Inc. It is expected that the employee demonstrate behavior consistent with the core values of WHMC and AHMC Inc... The employee shall support WHMC- Whittier Hospital Medical Center strategic plan, goals, and direction of the performance improvement plan. The employee will also be expected to support all organizational expectations including, but not limited to; Customer Service, Patient's Rights, Confidentiality of Information, Environment of Care and WHMC-and AHMC Inc. initiatives.

Qualifications

• High school graduate or GED equivalent preferred

• Minimum of 3-5 years admitting/ registration and/or business office background

• General knowledge of third party payors, PPO, HMO, POS, EPO, workers compensation, Medicare, Medi-Cal, and Cal-Optima preferred

• Knowledge of insurance authorization/ tracking/ pre-certification preferred

• Positive work ethic

• Excellent interpersonal skills

• Ability to communicate effectively

• Strong organizational skills

• Computer and typing skills preferred

• Medical terminology preferred