SLEEP Insurance Verification Rep Full Time Days

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

• Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional and financial well-being.
• Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

Full Time, IN OFFICE, 40 hours/week

Required:   Knowledge of medical, insurance terminology, and ICD codes.

Preferred:  3-4 years of  healthcare related experience

 

The Insurance Verification Representative reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Insurance Verification Representative confirms accuracy of and verifies insurance benefits for non-government payers (managed care) on new patients for the Wheaton inpatient acute and sub-acute programs.

Responsibilities:

• Pre-certifies with insurance or obtains case management or insurance adjuster's approval for planned services or procedures.
• Uses the pre-determination process to determine coverage for procedures in question.
• Provides detailed information to admissions staff, clinical referral liaisons, case managers, nursing staff and physicians when appropriate.
• Discusses financial responsibility with pending patients as needed.
• Obtains and coordinates preliminary case management authorization.
• Coordinates information from the patient, physicians and office staff, clinical referral liaisons and employers as needed to and complete the verification process.
• Obtains third-party pre-certification and concurrent review information and communicates to the admissions staff, clinical referral liaisons, case managers, appropriate physician departments and payer representatives.
• Communicates any changes in patient's clinical status to third-party payer to ensure authorization is current and accurate and provides notice of patient admission into the facility.
• Keeps insurance verification tracking log current and available to admissions staff and clinical referral liaisons with the most up-to-date status of patients in the verification queue.
• Communicates situations projected to result in a significant non-covered balance to the department director.
• Communicates corrected information and acts as a resource to admissions staff, clinical referral liaisons, case managers and others regarding contract guidelines and pre-certification requirements.
• Notifies admissions staff, clinical referral liaisons and department director when medical review is required.
• Reviews and analyzes financial information from third party payer systems and communicates that information to the business office and appropriate servicing department.
• Keeps up-to-date on trends and issues that affect reimbursement.
• Performs verification/certification function using alternative processes in case of downtime or disaster.
• Tracks and records insurance denial trends, and manages the appeal process on behalf of patients.
• Collects accurate financial data and enters into Meditech.
• Works with admissions staff, clinical referral liaisons, case managers and other departments ensuring financial data integrity is maintained and critical elements are reflected in the patient record.
• Maintains a strong customer focus while working collaboratively within a team to meet multiple demands, patient needs and coverage.
• Maintains confidentiality of all information.
• Suggests quality improvement ideas and participates in education and improvement efforts.
• Provides communication to patients, patient financial services, and case managers on insurance findings.
• Contacts patients, guarantor and business offices to inform of financial responsibility and attempts to coordinate financial arrangement.
• Produces projected benefit letters for patients and acts as a point person for counseling.
• Communicates benefit detail to admissions staff, clinical referral liaisons and case managers to ensure notification and collection of co-pays, deductibles and outstanding balances.
• Coordinates additional information requests as may be necessitated by third party administrators.

AA/EOE.

Qualifications

Required:

• High School or Equivalent (GED).
• Knowledge of medical, insurance terminology, and ICD codes.
• Ability to understand and communicate financial information.
• Ability to work independently.
• Excellent communication skills.
• Strong customer service focus.
• Resourceful with problem solving.
• Well-organized and efficient.
• Demonstrates proper telephone customer skills.
• Must be able to perform multiple tasks with composure and confidence.
• Ability to maintain composure under pressure.

Preferred:

• Three to four years of health-related experience.
• Associate's or Bachelor's degree.
• Highly proficient computer skills.

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.