Verifies insurance eligibility, benefits and correct Guarantor set up for hospital based encounters, clinic based encounters and other registration based encounters. Performs initial set up, corrections and updates to accounts in order to ensure accurate information for claims processing.
Responsibilities/Job Description
Responsible for working assigned work queues on a daily basis and maintaining established quality and productivity goals.
Responsible for the insurance verification of various visits; elective, emergent, urgent, and inpatient. Including but not limited to determining and documenting deductible, co-pay, and coinsurance.
Verifies coverage, Filing order, patient liability, correct account set up, and guarantor for patient encounters and visits.
Completes/corrects the set- up of insurance information. Verifies insurance eligibility through RTE as well as through numerous web based tools including insurance websites and calling insurance companies and adjusters.
Responsible for taking incoming internal and external customer calls, as well as making outgoing customer calls when necessary.
Participates in improvement efforts and initiatives that support the organizations goals and vision.
Responsible for communicating any insurance changes and issues with the Manager or site as directed.
Notifies designated financial resource of inadequate insurance coverage so that appropriate financial arrangements can be made.
Subject matter experts on Payor Grids, Changes and Payor plan IDs.
Other responsibilities and task as assigned.
Qualifications
Education Minimum Education
What is the minimum level of education needed to perform this job, if any?
High school diploma or GED equivalent
If degree required, in what area?
Preferred Education
What level of education is preferred for this job, but not required?
College degree in business or healthcare related fields
Minimum License/Certification/Registration
What License/Certification/Registration is required for this position?
Preferred License/Certification/Registration
What License/Certification/Registration is preferred for this position, but not required?
Experience: Minimum Experience
What is the minimum level of experience needed to perform this job, if any?
Three or more years of healthcare experience
Preferred Experience
What level of experience is preferred for this job, but not required?
Additional Requirements:
List position requirements not described above (e.g., computer hardware/software, other office equipment, laboratory equipment, prior supervisor experience, etc.)
Three or more years of healthcare experience
Excellent communication skills including the demonstrated ability to speak, listen and write effectively (i.e. strong verbal, written, presentation and interpersonal communication skills
Demonstrated ability to coach and mentor employees
Focus on delivering business results
Demonstrated ability to problem solve and use critical thinking
Ability to comprehend business issues and processes and identify process improvement opportunities and trends
Thrives in a team environment
Strong attention to detail and organization
Proficient in MS office products
Experience in the healthcare industry preferred
Previous supervisory experience
One year of working with patient complaints or disputes
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.
