Insurance Verification Team Lead, Ambulatory Patient Access

MISSION STATEMENT: Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time. VISION: Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

• This position will determine insurance eligibility and financial status by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits, which include the effective dates of coverage, patient financial responsibility, referral and authorization requirements, in and out of network benefits and maximum coverage. He/She will have the over site for the Insurance Verification Specialists and/or other designees as deemed necessary by the Director, and performs select administrative/clerical duties that assist in the delivery of overall patient care and customer satisfaction. POSITION EDUCATION/ QUALIFICATIONS­ :
• High School Diploma/ GED is required
• Good understanding of insurance benefits and medical terminology
• Previous healthcare experience (2-3 yrs.) is required, physician or hospital experience preferred
• Previous training and employee supervision (1 yr.) preferred
• Knowledge of Microsoft Office suite, working knowledge of Excel required
• Excellent customer service and interpersonal skills
• Good written and verbal communication skills, with the ability to read, write and speak English are required
• Ability to communicate clearly and concisely with all levels of management JOB KNOWLEDGE/EXPERIENCE­ :
• Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred.
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Requires reasoning ability, good independent judgment and organizational skills
• Requires working with frequent interruptions
• Must project a professional image

• POSITION RESPONSIBILITES:
• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Ensures timely response to Rejection and Discrepancy Reports
• Completes assigned reports or tasks as assigned by Director within timeline or by given deadline
• Monitor IV staff productivity through reports and ensure the team remains at least 3 days ahead in verifying insurance for patients on provider schedules
• Creates work schedule for team members taking into account times of the month when additional hours are needed to accommodate clinic business and control of overtime. Ex. Beginning of the month, MCD patients
• Ensures verification of benefits for all accounts on the daily visit schedule and pre-admission roster for the next day’s services
• Becomes the “go to” person for providers and management issues and the trainer for all team members in the Insurance Verification group
• Confirms billing address, in and out of network benefits and maximum coverage
• Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage.
• Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
• Ability to determine timely filing deadline for all insurance carriers
• Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier
• Ability to identify the appropriate coordination of benefits for insurance carrier
• Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits
• Determines financial status and refers patient for financial screening as appropriate
• Ensures referral/pre-authorization/pre-certification requirements have been met
• Obtains pre-certification approval as needed
• Obtains date of injury, compensable bodily injury, adjuster’s name, onset of illness and claim number, for worker’s compensation claims, as needed
• Completes reports as assigned by management within required timeframes
• Reviews physician order(s) for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
• Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Document clearly and concisely all patient benefit information on accounts through the computer system
• Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required
• Has appropriate follow up and contact with hospital or patient as necessary
• When working at the reception desk, checking patients both in and out of the practice properly documenting registration and other notes in the computer, as needed
• Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
• Other duties as assigned LINES OF REPSONSIBILITES : (Chain-of-command) 1. Director Ambulatory Patient Access 2. VP of Revenue Cycle 3. Chief Ambulatory Officer Other information: CUSTOMER SERVICE: Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service. AGE SPECIFIC : Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age. AMERICANS WITH DISABILITIES ACT: (ADA) : A.

Indicated by bold print within performance standards, preceding individual numbered criteria. The following table provides physical requirements that will be associated with, but not limited to, this position: Light/moderate lifting up to 20 lbs, from the floor to shoulder height. Yes Kneeling Yes Must be able to assist other employees with lifting more than 20 lbs.

Yes Walking Yes Light/moderate carrying up to 20 lbs. Yes Standing/Squatting Yes Straight pulling Yes Sitting Yes Pulling hand over hand Yes Pushing Yes Repeated bending Yes Stooping/Bending Yes Reaching above shoulder Yes Climbing Stairs Yes Simple grasping Yes Climbing Ladders No Dual simultaneous grasping Yes Depth Perceptions needed Yes Ability to see Yes Identify Colors Yes Operating office equipment Yes Twisting Yes Operating mechanical equipment Yes Crawling No Ability to read and write Yes Ability to Count Yes Ability to hear verbal communication without aid Yes Operating Personal Vehicle Yes Ability to comprehend written/verbal communication Yes Other: Ability to deal with stress Yes OSHA Category III B.

Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes : HIGH 1 2 3 4 5 6 LOW Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3 Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively.

To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3 Numerical: Ability to perform arithmetic operations quickly and accurately. 2 Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2 Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3 Clerical Perception: Ability to receive pertinent details and verbal or tabular material.

To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2 Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3 Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3 Manual Dexterity: Ability to move hands easily and skillfully.

To work with hands in placing and turning motions. 3 Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3 Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3 I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date. Employee Signature: ________________________________ Date: ____________________ Transfer/Hire Date Effective: ________________________.