Insurance Verification Representative I - Inpatient Rehab - Days

Hourly Pay Range:

$19.89 - $28.84 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights:

• Position: Insurance Verification Representative I
• Location: Northwest Community Hospital, Arlington Heights, IL
• Full Time/Part Time: part-time - 32 hours per week
• Hours: Monday, Thursday, Friday 7:30-4 (hours flexible). Tuesday, Wednesday 8-12:00
• Required Travel: no

A Brief Overview:
The Insurance Verification Representative will be under the management of the Manager, Patient Access, the Pre-Certification Representative I is responsible to determine insurance eligibility and, as appropriate benefits, pre-authorization / pre-certification and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative I provide this service to ensure that our customers are provided a high-quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative I help to ensure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized.


What you will do:

• Use Endeavor Health protocol to verify patient selection.
• Performs online eligibility and benefit checks for applicable payers as outlined in guidelines.
• Enters data accurately into Epic in accordance with standards.
• Calls the insurance company directly to obtain required eligibility and benefit information for all managed care, governmental and commercial payers,
• Verifies if pre-certification is required.
• Process accounts according to performance standards - timing, volume and quality
• Use NorthShore protocol to verify patient selection.
• Utilize established protocols to register patient (e.g. select insurance and guarantor, verify/enter demographic information)
• Provide instructions to patient (e.g. prep instructions related to procedure, location, co-pay)
• Accesses Medicare LMRP software to determine if ABN (Advance Beneficiary Notice) is required.
• Ascertain medical necessity requirements for visit utilizing NEBO Eligibility Software.
• If medical necessity check fails, contact physician for more appropriate diagnosis if available.
• Generate and complete ABN when needed and contacted the ordering physician and patient as outlined in procedural guidelines to communicate and explain requirement.
• For pre-registered patients, fax the ABN to the responsible check-in area (department or registration) for the service.
• Document all activities in Epic appropriately.
• Process accounts according to performance standards - timing, volume and quality
• Contacts physician office or insurance company to check status of and / or obtain existing precertification number for ordered service.
• Documents obtained information including certification number and number of days approved for inpatients into Epic.
• If authorization is not obtained as required, contact physician office and department regarding cancellation of procedure.
• If authorization is not obtained due to medical necessity, contact ordering physician's office and patient regarding waiver requirement.
• Generate and forward waiver as needed to department for patient signature.
• Follows standards for documenting cases and forwarding to Financial Counseling.
• Identify if callers have an existing NorthShorConnect account.
• If not, introduce NorthShoreConnect and encourage patient use.
• Utilize Epic to create NorthShoreConnect account for patients.
• Apply HIPAA guidelines to all situations, as appropriate.
• Follow all NorthShore protocols to ensure compliance with HIPAA.
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What you will need:

• High School Required
• 1 Year of experience in a contact center, healthcare environment or customer service role. And
• Experience with referrals and pre-certification strongly preferred.
• Basic math skills
• Basic computer skills
• Typing speed of 30 wpm
• Demonstrated record of excellent customer service skills
• Strong verbal communication skills: ability to speak clearly and articulate to customers and co-workers.
• Strong written communication skills to record patient activity in Epic.
• Strong active listening skills to effectively assist multiple customer types and identify ""panic"" or ""hot"" words.
• Ability to display empathy when dealing with customers.
• Critical thinking skills
• Decision-making and problem-solving skills
• Strong attention to detail to accurately en