Insurance Verification Representative II

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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OU Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

OU Health is a comprehensive healthcare provider offering a wide range of medical services including pediatric care, cancer care, diabetes care, emergency care, and specialized services for adults and children. Located in Oklahoma, OU Health operates multiple facilities such as the Oklahoma Children's Hospital and the Stephenson Cancer Center. Known for its advanced scientific research and quality care, the organization prides itself on being recognized for excellence in areas like pediatric cardiology and heart surgery. As part of its commitment to medical excellence, OU Health also focuses on medical education and research, helping to train the next generation of healthcare professionals.

📋 Description

• 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 or 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 for compliance with payor-specific rules, including the Medicare 72-hour rule • Communicate with physicians and case managers to resolve authorization or referral issues • Document benefit and authorization information in standard EMR screens and notes • 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 for 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 • Perform other duties as assigned

🎯 Requirements

• High School Diploma or GED required • 3 or more years of experience in hospital Patient Access required • 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 • 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 • Ability to perform responsibilities with or without an accommodation • Knowledge of Medicare and other payor-specific rules and regulations • Ability to follow scripted benefits verification and pre-certification format • Ability to calculate patient cost share and arrange payment or collection via phone

🏖️ Benefits

• Comprehensive benefits package • PTO • 401(k) • Medical plans • Dental plans • Total benefits and compensation package designed to support needs inside and outside the work environment