Healthcare isnt just changing. Its growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And thats what fueled these exciting new opportunities.
Who are we? Optum360. Were a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, well leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.
If youre looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. Its an opportunity to do your lifes best work.
Employing excellent customer service skills, the Insurance Verifier Specialist is responsible for ensuring a positive patient experience throughout the registration process. Primary duties include appropriate patient identification, collecting accurate and thorough patient demographic and insurance information to ensure appropriate reimbursement, determining and collecting patient financial liability, and ensuring referral to financial counseling as needed. Adheres to organization policies for the resolution of patient financial liability and various payment options.The Insurance Verifier Specialist is an information source for patients and families by explaining hospital policies, patient financial responsibilities and Patient Rights and Responsibilities.
Verification, Authorization and Compliance:
Maintains up - to - date knowledge of specific registration requirements for all areas, including but not limited to: Main Admitting, OP Registration, ED Registration, Maternity, and Rehabilitation units.
Ensures the pre - registration process is complete for all assigned accounts at least 5 - days prior to the scheduled date of service whenever possible.
Verifies insurance eligibility and benefits on all assigned accounts using electronic verification systems or by contacting payers directly to determine level of insurance coverage. When contacting payers directly, utilizes approved scripting.
Obtains referral, authorization and pre - certification information and documents this information in the ADT system.
When appropriate, ensures the payer receives a Notice of Admission on all admissions, scheduled and non - scheduled, within 24 - hours or the next business day.
Meets CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other requirements applicable and documenting completion within the hospitals information system for regulatory compliance and audit purposes.
Follows up on missing authorizations. If authorization is not obtained within 48-hours prior to service, contacts patient to advise them of their financial responsibility.
Thoroughly and accurately documents insurance verification and authorization information in the ADT system, identifying outstanding deductibles, co - payments, co - insurance, and policy limitations, and advises patient and collects amount due at or before the time of service.
Identifies any outstanding balance due from previous visits, notifies patient during the financial clearance process and requests patient payment.
Sets up payment plans for patients who cannot pay their entire current co - payment and / or past balance in one payment.
Explains the Payment and Billing Assistance Program to all patients regardless of financial concerns or limitations.
Interviews self - pay patients to identify potential eligibility for government aid and / or other payer sources, including Medi - Cal / Medicaid presumptive eligibility. Follows appropriate policy and / or refers to eligibility vendor.
Understands and follows the Delay / Defer policy and escalates accounts that do not meet financial clearance requirements to Patient Registration leadership immediately.
For patients who qualify, offers a flat rate discount based on estimated charges, percent of reimbursement, and / or hospital specific policy and procedure.
Thoroughly and accurately documents the conversation with the patient regarding financial liabilities, agreement to pay and/or payment assistance.
Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensures this information is clearly documented in the ADT system.
Verifies medical necessity check has been completed for outpatient services. If not completed and only when appropriate, uses technology tool to complete medical necessity check and / or notifies patient that an ABN will need to be signed.
Responsible for reviewing assigned accounts to ensure accuracy, and to ensure require documentation is obtained and complete.
Financial Processing and Assistance:
Provides financial clearance services to self - pay patients prior to discharge or within 24 business hours.
Provides on - site customer service assistance for walk - in patients with billing - related questions.
Provides information to hospital personnel who are seeking answers to financial concerns on their patients behalf.
When needed, works closely with Case Management / Utilization Review in ensuring services are appropriate for level of care provided (inpatient vs. outpatient and vice versa).
Acts as resource to other hospital departments regarding insurance benefits and requirements and collaborates with other departments, as needed, to ensure proper compliance with third party payer requirements.
Understands and follows the Cashier policy and procedures.
When collecting patient payments, follows policy and procedure regarding applying payment to the patients account and providing a receipt for payment.
Properly handles credit card transactions in accordance with PCI - DSS standards and guidelines. Will have access to both single card transactions as well as access to data from multiple transactions or reports and files containing bulk transactional information containing un - encrypted or un - redacted credit card information.
If required by facility inventories and stores patients valuables following proper procedure.
Works with physician offices and clinical areas to collect and share patient information, and to update these stakeholders on changes in patient registration requirements, processes and program.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.