Insurance Verification Representative I

Hourly Pay Range:

Insurance Verification Representative I

Position Highlights:

• Position: Insurance Verification Representative I
• Location: Arlington Heights, IL
• Part-Time
• Hours: Various days per week, 1 evening shift till 6:30/7:30 pm, Rotating weekends every 5th - 6th Saturday
• Required Travel: no

Job Summary:

Reporting to the Rehabilitation Service Manager works with patients and their representatives and insurance carriers and employers to determine patient benefits eligibility, pre-certify services and performs verification of benefits to ensure revenue reimbursement. Screens registration data for compliance with payer and pre-certification requirements, corrects and updates accounts and bills to the appropriate party. Services primarily includes, but not limited to Physical Therapy, Occupational Therapy and Speech Therapy.

What you will do:

• Reviews and analyzes all required demographic, insurance/financial, and clinical data procured by patient intake and registration areas necessary to expedite payment on patient's accounts

• Resolves all issues including obtaining information and signatures on documents required by the patient's insurance carrier
• Corrects information in both the Patient Management System and Patient Account Systems. Interacts, via telephone and in person, with patients, their representatives, physicians, physician's office staff, employers, and others, and reviews new and previously recorded patient, insurance and procedural information
• Electronically records all phone interactions and records resolution to follow-up items in a timely manner.
• Performs pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payer requirements.
• Contacts insurance companies to determine preauthorization requirements for Outpatient Rehab Services
• Coordinates with clinic staff to add and update insurance and perform verification and reverification of insurance benefits.

• Determines eligibility, coverage details, and benefits utilizing online resources or phone calls with the insurance company
• Communicates status of verification/authorization process with appropriate team members in a timely and efficient manner
• Confirms referral requirements for individual plans and works with referring physician offices as needed to obtain referrals for all scheduled services, including referrals for additional office visits
• Works productively and efficiently from a task-based work queue. Maintains an acceptable level of productivity as determined by the Rehab Services department to meet business needs though volumes may vary.
• Verifies completeness and accuracy of all information prior to resolving tasks in the work queue.
• Analyzes, investigates, and resolves all authorization denials, appeals, and medical necessity requests. Researches and assists with denied authorizations.
• Utilizes work queues to initiate verifications/authorizations and communicate across functional areas to ensure authorization is in place at least 48 hours prior to the scheduled procedure
• Acts as a liaison between clinical staff, patients, referring physician offices, and insurance by informing all parties of coverage issues, including answering questions, helping, and relaying messages pertaining to verification and authorization
• Performs department appointment reports (DAR) to identify registration and authorization issues on a regular basis. Attends weekly/monthly department meetings.
• Responds in a timely manner to emails, in-basket messages and telephone messages as appropriate. Communicates issues to management, including payer, system or escalated account issues.

• Performs other duties as assigned by Manager.

• What you will need:
• Education: High School diploma or GED required. Associates Degree preferred
• Certification: Valid driver's license is required if the incumbent is selected to perform related duties at an off-site location. If incumbent uses their personal vehicle, the incumbent must maintain automobile liability coverage as required by law and evidence of such coverage may be requested.
• Experience: Minimum of one to two years of registration, scheduling, or customer service experience in a healthcare setting preferred.
• Unique or Preferred Skills:
• Knowledge of health insurances, medical terminology and anatomy preferred.

• Strong data entry and keyboarding skills preferred.

• Knowledge of Microsoft Office Suite preferred. Manual dexterity to operate various office machines required.

• Basic level of analytical ability is required in order to read and understand simple instructions, enter date into logs, charts, and records, maintain files and the like.

• Significant level of interpersonal and verbal communication skills are required in using tact and sensitivity to conduct interviews for the exchange of information on factual matters, understand and transmit instructions, and interact with patients, physician offers, various administrators, other hospital personnel and external contacts.

• Work is performed in accordance with detailed hospital and department policies and procedures but it does require technical knowledge or in-depth, experience-based knowledge in order to analyze and interpret information.

Physical Requirements: Work requires the ability to walk or stand for an hour or extended periods at a time, lift or carry objects weighing more than 20 pounds, push or pull supply carts, gurneys or wheelchairs, closely examine images or reports, proofread and check documents for errors, use a keyboard to enter, retrieve or transform words or data.

Benefits (For full time or part time positions):

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.