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Job Summary:

The Senior Representative, Insurance Verification obtains insurance authorization and/or verification for patients who require services at
Mary Washington Healthcare.

Essential Functions & Responsibilities:

• Monitors reports or work queues in accordance with the insurance verification and authorization processes to ensure timely notification and insurance verification processing. Processes insurance verifications through various systems and websites.

• Utilizes multiple resources to verify eligibility, coverage, and authorization/pre-authorization requirements have been met. Confirms authorization is appropriate for scheduled service(s), data span, facility, etc.

• Collaborates with Information Systems in testing of upgrades, new applications, and monitoring of added scheduling service lines and/or insurance payor vendors. Incorporates a root cause analysis approach to identify underlying issues.
• Confirms staff access to software applications, websites, insurance databases, and any additional resources to perform daily
work assignments. Maintains proficiency within applications to ensure ongoing efficiencies and cost-saving initiatives.
•Places clinical documentation submitted with the order into the patient chart for securing insurance authorization as necessary.
• Maintains compliance and appropriate assignment (primary, secondary, etc.) for coordination of benefits. Initiates admission notifications to payers. Communicates patient/guarantor financial responsibility, co-pay, deductible and/or self-pay deposits.
• Audits, reviews, and research training opportunities for departmental staff to include, on-going training, practicing scheduling and insurance verification of complicated or new services in a test environment, creation of tip sheets, and providing discussion/presentation on work-related subject matters for staff education.
• Secures accounts for services in a timely manner. Communicates patient waivers and Advanced Beneficiary Notifications to appropriate customers, registration areas, and clinical departments.
• Reviews patient data for accuracy and completeness of demographic and insurance information and reviews and makes appropriate changes when needed. Reports audit findings and identifies and recommends process improvements within the registration and insurance verification processes.

• Understands the workflow of the entire patient access process and works with the team to ensure efficient workflow
management.
• Provides mentoring and coaching when needed to maintain positive morale and teamwork.
• Performs other duties as assigned.

Qualifications:

• High school diploma or equivalent required.
• Two (2) years of experience in any of the following disciplines healthcare, registration, or insurance required.
• Familiarity with diagnostic and/or surgical procedures in a hospital setting required.
• Ability to explain benefits details and authorization requirements to internal and external customers required.
• Strong verbal and written communication skills required.
• Strong customer service and telephone skills required.
• AAHAM Certified Revenue Cycle Specialist (CRCS) or related industry certification preferred.
• Proficient computer skills, Word and Excel preferred

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.