INSURANCE VERFICATION SPECIALIST
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.
The Insurance Verification Specialist (IVS) is responsible for all processes necessary to obtain benefits and required pre-certifications of patient accounts in order to secure third party reimbursement. Utilizing available technology and resources, the IVS must remain knowledgeable of changing guidelines and regulations of third party payors, ensuring that patients comply with all third party policies and managed care requirements in order to guarantee payment to the hospital. The IVS follows the length of stay, ensuring that all inpatient days are appropriately authorized, while at the same time, identifying co-pays and high dollar deductibles and other out of pocket expenses. The IVS takes the necessary steps to protect the patient and the Hospital from financial loss by expediting the financial clearance process. The IVS exercises good judgment and effectively communicates with other departments and physician's offices when problems arise, formulating viable solutions to resolve them. The IVS is responsible for reporting potential problem areas that may inhibit a complete account and may deter the billing and collection of the accounts receivable. The IVS provides assistance to other Access Areas as deemed necessary and appropriate.
- 1. VERIFIES INSURANCE BENEFIT INFORMATION AND ENSURES NOTIFICATIONS AND PRECERTIFICATIONS ARE OBTAINED AND ADEQUATE IN ORDER TO OBTAIN MAXIMUM HOSPITAL REIMBURSEMENT AND Clearly communicates with the PAR and Care Coordinator staff when insurance has changed, alleviating any possible coverage issues and ensuring a prompt discharge for the patient.
- 1.1 Obtains insurance eligibility and benefits utilizing the On Line Eligibility system or any other means (i.e. telephone, fax or various third party payor websites) within 24-48 hrs of emergency admissions. When necessary, alerts the appropriate staff of insufficient and or termination of benefits.
- 2. UTILIZING EFFECTIVE COMMUNIATION AND NETWORKING SKILLS TRACKS AND PROVIDES INFORMATION TO OTHER HOSPITAL DEPARTMENTS, PHYSICIANS OFFICES AND THIRD PARTY PAYORS TO ENSURE ALL INSURANCE REQUIREMENTS ARE MET THROUGHOUT PATIENTS STAY AND IN PLACE IN ORDER FOR TIMELY BILLING AND PAYMENT TO BE SECURED.
- 2.1 Determines patients initial approved length of stay by telephone contact with third parties and/or online computer systems. Immediately communicates any discrepancies to the Hospitals Utilization Management Department both during and after the patients hospitalization.
- 3. TAKES STEPS TO IDENTIFY THE UNINSURED AND UNDERINSURED. Alerts the appropriate staff when potential limitation of coverage is discovered in order to determine alternative methods for payment or makes referrals to agency assistance.
- 3.1 Acts as a representative of the Hospital by establishing and maintaining open communication (verbal or written) with Hospital personnel, third party payers, employers, various agencies, and clinicians to provide for the financial well-being of the patient, while protecting the financial position of the Hospital.
- 4. PROMOTES EXCELLENCE IN CUSTOMER SERVICE AND THE I AM YALE NEW HAVEN PLEDGE THROUGHOUT THE ORGANIZATION- Works with Hospital and Health System staff to promote service excellence while coordinating the medical assistance application process. Presents a positive image of the department, at all times displaying the behaviors described in the I Am Yale New Haven pledge.
- 4.1 Comprehends the needs of our customers and ensures they are met in accordance with the standards stated in the Service Excellence Pledge. Imitates referrals to the appropriate person or department for resolution when necessary.
- 5. DEMONSTRATES THE ABILITY TO MANAGE NEW TECHNOLOGICAL RESOURCES AND PROCESSES BY MAINTAINING COMPREHENSIVE KNOWLEDGE OF THE VARIOUS COMPUTER ANDS SOFTWARE SYSTEMS NECESSARY TO MANAGE DAILY OPERATION IN A WAY THAT IS EFFICIENT FOR SERVING CUSTOMERS AND ATTAINING HIGH PRODCUTIVITY STANDARDS.
- 5.1 Maintains a strong working knowledge of SDK, SCM, Image Now, On Line Eligibility, DSS Verification systems, third party websites and email lists in order to support and efficiently manage the financial assistance process.
- 6. SUPPORTS ORGANIZATIONAL AND DEPARTMENTAL GOALS by performing all functions in accordance with established policies and procedures. Consistently and actively participates in in-services and training courses offered through the department, Hospital and the IFE in order to ensure knowledge is current and applied appropriately.
- 6.1 Reviews all memos and procedure updates as received. Demonstrates and applies a sound knowledge of these policies and procedures, identifying any obstacles or changes that may require a change in our internal processes.
(number of years and type required to perform the position duties): High school graduate with business or accounting related courses. Enrolled or working toward Associate Degree preferred.
Two (2) or more years experience in an Access/Healthcare or insurance claims related environment with a strong customer service background. Hospital third party experience preferred.
Self directed, well organized and exhibiting excellent interpersonal and team oriented skills with a strong ability to interpret insurance benefits and apply to hospital services. To protect the patient and the Hospital from financial loss must have strong communication skills with the ability to communicate complex requirements across clinical and financial disciplines. Comprehensive PC proficiency, keyboarding skills and the capability to navigate various software and spreadsheet systems.
See Inside the Office of Yale New Haven Hospital
Yale New Haven Hospital provides diverse comprehensive care in over 100 medical specialties. As the primary teaching hospital of the Yale School of Medicine, YNHH provides around-the-clock coverage and insightful, research-supported patient care. In addition to providing quality medical care to patients and families, Yale New Haven Hospital is the second largest employer in the New Haven area, with more than 12,000 employees.
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