Insurance Verification Representative II
Full Time, 7:45 a.m. to 6:15 p.m., 30 Hours/Week
Nemours duPont Pediatrics, Deptford
1280 Almonesson Road, Deptford, NJ 08096
Job Description & Requirements:
Nemours is seeking an Insurance Verification Representative II to join our Outpatient Therapy Services team in Deptford, NJ.
As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
As the birthplace of the Nemours health care system, the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, honors our legacy of delivering exceptional care to the children of the Delaware Valley and beyond. Ranked among the nation’s best pediatric hospitals by U.S. News & World Report and honored with the ANCC’s Magnet® Designation for excellence in nursing practice, we offer intensive and acute inpatient and outpatient services covering more than 30 pediatric specialties. We recently completed a multi-phase hospital expansion that includes new inpatient rooms, Pediatric Intensive Care Unit and Emergency Department. Additionally, Nemours duPont Pediatrics allows us to reach more children across the region through community-based physician services and collaborative partnerships with health and hospital systems.
To learn more about Therapy Services at Nemours, please click this link: https://youtu.be/iZNJNSQFdBI
Responsible for accurate and complete patient accounts based on departmental protocol, policies and procedures and for compliance with regulatory agencies to include, but not limited to, pre-registration and registration functions, timely and accurate appointment scheduling, and co-pay collection. Ensure all insurance requirements are met prior to patients' arrival, and inform patients of their financial liability.
This position has high customer service with our patients, payors and physicians by phone and in person and requires excellent customer service skills.
Greets patients and families in person or by phone using AIDET. Maintains a friendly and welcoming atmosphere in a busy and public work environment. Maintains patient confidentiality.
Collects and documents accurate patient demographics and insurance information.
Analyzes insurance coverage and benefits for service to ensure timely reimbursement.
Obtains all prior authorizations as appropriate based on insurance plan contracts/guidelines and documents in Epic system per policy and procedure.
Enters and updates referrals as required.
Communicates with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.
Notifies families of insurance limitations or potential out-of-pocket costs for requested services.
Facilitates referral to Financial Services for payment sources for uninsured patients.
Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program.
Registration functions (including but not limited to):
Requests picture ID 100% of the time during initial check-in of evaluation.
Systematically collects consents and other required documents (real-time).
Verifies insurance cards and other important documents (real-time).
Collects and posts co-pays and any past-due balances, and reconciles money at the end of the shift, as required by program.
Schedules follow-up appointments as needed.
Achieves a daily “after visit” verification (insurance and demographics) percentage of ≥ 95%.
Alerts clinical staff of patient arrival, and communicates with clinical staff as to the status of patients waiting more than 10 minutes after scheduled visit.
Accurately records status of therapy appointments, differentiating no-show versus cancellation, etc.
Handles triage of “walk down" appointments for scheduling and insurance approvals.
Works collaboratively with clinical staff, Central Business Office, financial counselors, etc., to ensure coverage and payment are obtained for all services rendered.
Identifies trends and alerts managers and supervisors to plan benefit changes that may affect services.
Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators, etc.).
Must have ability to work well with others.
Regular attendance required.
Good communication skills are required, both written and verbal.
Demonstrates commitment to the 10 Nemours Behavior Standards.
Gives accurate information.
Accepts and gives constructive feedback.
Sets priorities and can adjust to meet department demands or changes; manages time.
Works as a team with other department staff.
Stays current on knowledge relevant to the position.
Works independently/thinks proactively.
Builds and fosters professional relationships.