Eagleville Hospital
Evening Insurance Verification Specialist
Eagleville Hospital, Eagleville, Pennsylvania, us, 19415
Evening Insurance Verification Specialist
Position: Full‑time (Evening Shift) – Monday – Friday, 3:00 PM – 11:30 PM
Job Summary The Insurance Verification Specialist is responsible for ensuring that all patient admissions have verified insurance coverage and, where required, completed pre‑certification/authorization prior to admission. This role is essential in supporting smooth patient intake, reducing claim denials, and safeguarding the hospital’s revenue cycle. The specialist works closely with Admissions, Utilization Review, and Clinical teams to confirm benefits, secure authorizations, and document all interactions with payors in accordance with hospital policy.
Essential Duties and Responsibilities Insurance Verification & Precertification
Accurately verify patient insurance eligibility, coverage, benefits, and policy limitations for all payors, including commercial, Medicare, Medicaid, and managed care.
Identify plan requirements such as pre‑authorization, pre‑certification, or referral mandates.
Obtain pre‑certification/authorization for inpatient, detox, psychiatric, and residential services before admission when applicable.
Initiate and develop client data in the Commonwealth of PA WITS system as required for applicable accounts.
Documentation & Communication
Record all verification details in the hospital’s EMR, NetSmart MyAvatar, and other required systems in real time.
Maintain accurate, detailed logs of insurance contacts, reference numbers, and call notes.
Communicate insurance coverage status and financial responsibility to the Admissions team promptly to support patient scheduling.
Notify leadership of any coverage issues, high‑risk cases, or patients requiring alternative funding arrangements.
Compliance & Coordination
Adhere to HIPAA and all confidentiality regulations regarding patient and financial information.
Follow hospital SOPs for insurance verification, pre‑certification, and admissions documentation.
Collaborate with Utilization Review to ensure ongoing authorizations are secured as required.
Stay updated on insurance policy changes, payor requirements, and state/federal regulations impacting coverage for behavioral health and substance use disorder treatment.
Other duties as assigned.
Details
Senior level: Entry level
Employment type: Full‑time
Job function: Other
Industry: Hospitals and Health Care
Location: Eagleville, PA
Referrals increase your chances of interviewing at Eagleville Hospital by 2x.
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Job Summary The Insurance Verification Specialist is responsible for ensuring that all patient admissions have verified insurance coverage and, where required, completed pre‑certification/authorization prior to admission. This role is essential in supporting smooth patient intake, reducing claim denials, and safeguarding the hospital’s revenue cycle. The specialist works closely with Admissions, Utilization Review, and Clinical teams to confirm benefits, secure authorizations, and document all interactions with payors in accordance with hospital policy.
Essential Duties and Responsibilities Insurance Verification & Precertification
Accurately verify patient insurance eligibility, coverage, benefits, and policy limitations for all payors, including commercial, Medicare, Medicaid, and managed care.
Identify plan requirements such as pre‑authorization, pre‑certification, or referral mandates.
Obtain pre‑certification/authorization for inpatient, detox, psychiatric, and residential services before admission when applicable.
Initiate and develop client data in the Commonwealth of PA WITS system as required for applicable accounts.
Documentation & Communication
Record all verification details in the hospital’s EMR, NetSmart MyAvatar, and other required systems in real time.
Maintain accurate, detailed logs of insurance contacts, reference numbers, and call notes.
Communicate insurance coverage status and financial responsibility to the Admissions team promptly to support patient scheduling.
Notify leadership of any coverage issues, high‑risk cases, or patients requiring alternative funding arrangements.
Compliance & Coordination
Adhere to HIPAA and all confidentiality regulations regarding patient and financial information.
Follow hospital SOPs for insurance verification, pre‑certification, and admissions documentation.
Collaborate with Utilization Review to ensure ongoing authorizations are secured as required.
Stay updated on insurance policy changes, payor requirements, and state/federal regulations impacting coverage for behavioral health and substance use disorder treatment.
Other duties as assigned.
Details
Senior level: Entry level
Employment type: Full‑time
Job function: Other
Industry: Hospitals and Health Care
Location: Eagleville, PA
Referrals increase your chances of interviewing at Eagleville Hospital by 2x.
#J-18808-Ljbffr