Insurance Verification Representative II - Central Insurance Verification Clinic Team

The Insurance Verification Representative II is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. This role serves as a lead within the department by performing advanced duties and assisting with staffing, quality assurance, reporting, and training.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Perform pre-registration and insurance verification for inpatient and outpatient services.

• Follow scripted benefits verification and pre-certification format in the EMR and document results.

• Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.

• Assign insurance plans accurately and perform electronic eligibility confirmation.

• Complete Medicare Secondary Payor Questionnaire as applicable.

• Calculate patient cost share and arrange payment or collection via phone.

• Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).

• Communicate with physicians and case managers to resolve authorization or referral issues.

• Document benefit and authorization information in the standard EMR screens and notes as needed.

• Implement system downtime procedures when necessary.

• Practice and adhere to the organization's Code of Conduct and Mission and Value Statement.

• Lead daily operations and assist staff with complex insurance verification issues.

• Monitor and reconcile reports to ensure timely and accurate processing.

• Support QA processes and assist management with audits.

• Train new staff and provide ongoing guidance to team members.

• Serve as point of contact for escalated issues with physicians, insurance companies, and case managers.

• Ensure compliance with Medicare and other payor-specific rules and regulations.

• Maintain documentation standards in the EMR.

• Coordinate with hospital departments and facilitate communication across teams.

• Assist with staffing coverage and workflow prioritization.

• Perform special projects and other duties as assigned by management.

General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications

Education Requirements

• High School Diploma or GED required.

Experience Requirements

• 3 or more years of experience in hospital Patient Access required.

License/Certification/Registration Requirements

• Certified Revenue Cycle Representative (CRCR) issued by the Healthcare Financial Management Association (HFMA) or Certified Healthcare Financial Professional (CHFP) issued by HFMA required within 180 days of hire.

Knowledge/Skills/Abilities Requirements

• Advanced communication and leadership skills.

• Strong analytical and problem-solving abilities.

• Proficiency in EMR systems.

• Ability to mentor and support team members.

• High level of accuracy and attention to detail.