Insurance Verifier/QC/Financial Counselor - SFMC Admitting in Lynwood, CA at Prime Healthcare

Date Posted: 7/14/2020

Job Snapshot

Job Description

Responsibilities The insurance verification /QC/ Financial counselor specialist must possess knowledge of the various payers i.e. commercial, Managed care, government plans and State programs, i.e. Medi-Cal/Medicaid and CCS.  The verifier/financial counselor is responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider. He/she is responsible for entering data in an accurate manner, as it is his/her job to update patient benefit information in the organization’s insurance system and verify that existing information is accurate. This position requires the individual to spend extensive amounts of time on the phone and /or insurance companies websites to ensure that all benefits have been verified for determination of authorization requirements.  This position also serves as a valuable resource to patients, providing them with pertinent information regarding their coverage. This position works with patients to explain coverage amounts provided by their insurance policy, so they can understand why some procedures may be covered, while others are not.  This position also assist patients with payment arrangement plans for services that are not covered by their insurance companies and/or for those self-pay patients.   Advises patients of any alternative sources of funding or assistance available from state and/or government agencies.  Calculates and collects cash packages by using Medicare DRG/APC reimbursement table.  Responsible for financially counseling patients at hospital bedside, OP registration and/or ER to obtain cash payment or determine eligibility for various governmental programs.  Set up arrangements / monthly installment agreements for patients to payoff balances within the guidelines of Prime Healthcare Systems collection policy.  Follows up on any self-pay patients that were missed within 3 days.  Work closely with Case Management (UR) daily in regards to patient status changes; whether this would include patient type or insurance notification or insurance coverage.   Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families.  This position is also responsible for the QC of all registered accounts in the department.  All accounts need to be corrected through the hospital QC computer system (AHIQA) and through the manual QC.  All data must be entered in the Manual QC folder found in the hospital SharePoint site.  This position must QC 100% of all inpatients, surgical accounts and 50% of outpatients and ER accounts.   

Education and Work Experience

  1. Knowledge of standard insurance companies, i.e. PPO, HMO, EPO, and their verification requirements.
  2. Knowledge of HPE, CCS programs eligibility and application process.
  3. Well versed in authorization processes for all payers.
  4. Ability to multi-task, prioritize needs to meet required timelines.
  5. Analytical and problem-solving skills.
  6. Customer Services experience required.
  7. High School Graduate or GED equivalent required.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law:  https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf