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Insurance Verifier / Financial Clearance Representative

Company: UMass Memorial Health Care
Location: Worcester
Posted on: January 14, 2019

Job Description:

Requisition #: 190739 Title: Insurance Verifier/Financial Clearance Rep Department: Revenue Cycle Grade: ADM5 Posting Date: November 21, 2018 Status: Non-Exempt Shift: Days Union: SHARE Hours: 40 Shift Length: 8 hours Location: 67 Millbrook Street, Worcester MA UMass Memorial Health Care is the largest health care system in Central Massachusetts. We are the clinical partner of UMass Medical School, with access to the latest technology, research and clinical trials. Our health care system includes four hospitals: * UMass Memorial Medical Center (Worcester) * UMass Memorial HealthAlliance-Clinton Hospital (Clinton, Fitchburg and Leominster) * Marlborough Hospital (Marlborough) In addition to our fully equipped medical centers, our system also includes home health and hospice programs, behavioral health programs and community-based physician practices. Position Summary: Performs a variety of complex duties utilizing insurance and payor knowledge to ensure that all inpatient admissions, surgical procedures, provider visits, tests and ancillary services are financially cleared prior to release of a claim to the insurance company. Position Qualifications: High school diploma required. Minimum of 1 year of business office or related insurance experience preferred. Knowledge of third party requirements as they relate to insurance verification/authorization. Demonstrated ability to work with computerized systems. Excellent communication skills to interact with insurance companies, physicians' offices, and patients. Major Responsibilities Works the referrals workqueue and verifies that all authorizations and pre-certifications are in place prior to services being rendered and align with provided CPT and ICD-10 codes. Investigates all elective same day surgeries and inpatient admissions for referral and/or authorization requirements. Verifies insurance eligibility utilizing available technologies, payor websites, or by phone contact with third party payors. Verifies patient insurance coverages using real time eligibility or batch processing as appropriate. Verifies that the correct insurance company name, address, plan, policy number and filing order are entered in the Epic system. Work patient and payor workqueues so that patient accounts are complete prior to services being rendered. Complies with referral management regulations established for primary care providers. Communicates with insurance companies regarding all urgent/emergent surgeries/admissions following payor guidelines. Financial clearance may consist of updates and corrections to patient demographic and insurance information, verifying benefit information and obtaining prior insurance referrals and authorizations. May collect patient liabilities on or prior to the date of service as appropriate. Complies with established departmental policies, procedures, and objectives. Attends variety of meetings, conferences, seminars, and on-going training as required or directed. Demonstrates use of quality improvement in daily operations. Complies with all health and safety regulations and requirements. Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. Performs other similar and related duties as required or directed.SDL2017

Keywords: UMass Memorial Health Care, Worcester , Insurance Verifier / Financial Clearance Representative, Accounting, Auditing , Worcester, Massachusetts

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