VHC Health

ID 2022-9465
Category Administrative
Job Locations
US-VA-ARLINGTON
Position Type
Full Time
Shift
Days
Department : Name
INSURANCE VERIFICATION

Job Detail

*Minimum one year Insurance Verification experience required

Overview

NEW VHC logo- JDs

 

Benefit Alternative Insurance Verification Specialist

 

This team member verifies registration information and insurance coverage eligibility by using online tools and system applications. Secures and documents authorization for scheduled / non-scheduled inpatient and ambulatory surgical procedure and outpatient radiology procedures. Ensures that all encounter information is correct for claim processing; responsible for communications with the patient and or designated individual; physician's office, utilization management, business office and insurance companies to secure specific services and requests.

 

Come join a hospital dedicated to you and your career!

 

VHC Health is a 453-bed nationally recognized Hospital and teaching facility that has been delivering high quality care to the Washington, DC metropolitan area for over 75 years. VHC is a proud member of the Mayo Clinic Care Network (a national network of independent healthcare organizations), a designated Level II Trauma Center and a recognized Magnet Hospital by the American Nurses Credentialing Center. We are proud to announce that the Leapfrog Group has awarded the hospital with an 'A' grade in Hospital Safety for the 19th year in a row, achieved an Outstanding Patient Experience Award™ for the 10th year in a row and VHC has ranked Number 2 in “Best Hospitals” in the Washington, DC metropolitan area by U.S. News and World Report's 2021-2022 rankings. At VHC we are always striving to provide continued excellence and growth for our employees as well as top notch care for our patients.

Qualifications

  • High School diploma or equivalent preferred
  • Previous experience in the medical field required
  • Experience in the field of health insurance, knowledge of medical terminology, general radiology procedures and HIPAA Regulations required

Responsibilities

  • Process verification and obtain authorization via email request(s) from specific department which has been prior arranged. Includes request prior to services being scheduled.
  • (RAD) Notifications are provide to the scheduling, registration areas via email when there are discrepancies with a patient's encounter(s) immediately. Including the physician's office.
  • Utilization Management is notified of via phone of any insurance updates and or urgent scenarios then documentation is entered in EPIC.
  • All benefit verification request for the Behavioral Health Unit are completed in a timely manner. Benefit verification of inpatient, outpatient, partial and intensive outpatient (IOP) are obtained and given to the Admitting Coordinator on the Behavioral Health Unit or IOP Department.
  • Adhere to the Business Office requests for any encounters requiring follow-up verification, resubmitting admission notice, obtaining Lifetime letters, providing notification for specific billing instructions and other information.
  • Any errors and or updated information is provide via email or phone to the appropriate department to help ensure consistency of patient information.
  • (RAD WL)Verify and complete at least 30 encounters per day and at least 150 encounters per week. All completed encounters are coded appropriately in the ONTRAC system as well documenting updates in Soarian Financials.
  • (Elective WL) Verify and complete at least 40 encounters per day and at least 200 encounters per week. All completed encounters are coded appropriately in the ONTRAC system as well documenting updates in Soarian Financials
  • (Urgent WL) Verify and complete at least 45 encounters per day and at least 250 encounters per week. All completed encounters are coded appropriately in the ONTRAC system as well documenting updates in Soarian Financials.
  • Personal productivity reports are maintained by the supervisor daily, thru the ONTRAC system. Productivity averages must be at least 90% or better for any given month.
  • ONTRAC Work List exceptions are coded and completed in a timely manner.
  • Accurate verification is required for all encounters and updated accordingly, i.e. HMO-Medicaid and Out of State Plans.
  • All newborn encounters are processed accordingly to the insurance guidelines and transferred to the Financial Assistance Department if applicable.
  • Verification to third party billing systems. Certification of coverage, policy information, claim addresses are obtained for each insurance carrier. Any necessary corrections are made to produce an error free claim.
  • Refers problem encounters to the Supervisor i.e. all encounters that are pending payer and physician action; or pre-existing clauses should be coded correctly in ONTRAC. All related documentation must be entered in Soarian Financials in a timely manner.
  • The verifier is responsible for obtaining the correct ID number, claim address, date of injury (DOI), adjuster name and contact number as well as the approval. All documentation is entered in Soarian Financial and or scanned into EDM.
  • If WC is not valid then insurance information needs to be obtained, verified and authorized. All documentation is entered in Soarian Financial and or scanned into EDM.
  • All points of contact are made when verifying insurance coverage before a patient account is changed to self pay. Points of contact: patient, patient designee, next of kin, POA, doctor's office, insurance company previous encounters. All documentation and updated information need to be recorded in Soarian Financials.
  • If no insurance coverage is obtained, then the account needs to be updated to Self Pay transferred to the Financial Assistance Department immediately. Or the appropriate department is contacted immediately. All supporting documentation is listed in EPIC. If applicable, encounters coded and transferred to the Financial Assistance Department in ONTRAC.
  • When notification of sponsorship is provided, verification and authorization is obtained; EPIC is documented; the appropriate department is notified and the encounter is coded in ONTRAC.
  • Verifies registration information. All patient/guarantor information and insurance plans are correct. Revisions are updated in the EPIC.
  • Verifies insurance benefits and obtains all necessary authorizations to secure each encounter prior to; on the date of; and or the following day of an emergency admission - whichever is applicable for the specific encounter.
  • Process any follow up with the physician office, insurance company, patient, patient designee, and or POA to secure the specific encounter(s). All verification calls are conducted courteously and tactfully. No medical information is released without proper authorization.
  • Verifiers only access patient encounter(s) when verifying insurance information; assisting patients; insurance companies; physician's office and the business office. All documentation is entered in Soarian Financials, Centricity and or scanned into EDM.
  • All information regarding the insurance verification of an encounter, including name, claim address, additional insurance information is obtained and documented in EPIC. All verification calls are conducted courteously and tactfully.
  • Procedure and Diagnosis codes are obtained from the OR Manager (Picis) or Centricity and documented with the verification notes. The physician's office is contacted immediately with any discrepancy with the listed or non listed codes.
  • All options are exhausted to obtain and secure the required information in order to secure the specific encounter(s) then documentation is entered in EPIC.
  • Scheduled inpatient or outpatient services authorization process is conducted prior to DOS or services are rendered.
  • All documentation for scheduled encounter(s) is updated in EPIC prior to the patient check in.
  • Patients are given a courtesy call when they are responsible for high deductible, have a pre-existing clause, rendering out of network services and or are receiving services that are not covered. Notifications of pending authorization status, if necessary.
  • Refers problem encounters to the Supervisor i.e. all encounters that are pending payer and physician action; or pre-existing clauses should be coded correctly in ONTRAC. All related documentation must be entered in Soarian Financials in a timely manner.
  • Accurate Medicare benefits, HMO and CWF information are obtained through Emdeon from the Direct Data Entry (DDE--Medicare online system). HMO and CWF information listed is verified, and updated in Soarian Financials.
  • Lifetime letters are obtained in a timely manner according to the encounter scenario.
  • Encounters with exhausted Medicare benefits are updated to show the valid insurance plan. All necessary authorizations are obtained from the secondary insurance.
  • If no secondary insurance, the Financial Assistance or the appropriate department is contacted immediately and the encounter is updated to Self Pay. All supporting documentation is listed in Soarian Financial.

Benefits

  • Paid Major Holidays
  • Generous Paid Time Off / Vacation
  • Sick Time
  • Health Insurance
  • Dental Insurance
  • Undergraduate Student Loan Repayment
  • Flexible Spending Accounts (FSA)
  • Health Savings Account (HSA)
  • Health Fitness & Education Class Discounts
  • Employee Wellness Benefits
  • Hospital Discount for Employees and Family
  • VHC Retirement Program
  • Tuition Reimbursement
  • Free onsite parking
  • Commuter Benefits
  • Career Coaching
  • Family Leave
  • 401(k) + Match
  • and much more!

 

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