City of Hope

Insurance

• Reviews and evaluates prospective and current patients' insurance coverage
• Obtains benefits via 40+ question interview process or online payer portals for hospital and physician services (inpatient/outpatient, in/out of network)
• Documents patient benefits in database repositories to support accurate billing and reimbursement
• Verifies new patient verifications and completes return verifications from work queues, email and SharePoint requests
• Verifies returning patients for continued benefit evaluation per financial policy
• Completes a required minimum number of records per day and provides daily counts via email
• Evaluates and estimates insurance policy coverage adhering to Patient Financial Acceptance Policy and site exceptions
• Performs initial financial screens to maximize reimbursement and minimize uncollectible balances
• Interprets and communicates insurance benefits to OIS, care managers, registration, billing, CFOs, and other stakeholders
• Completes administration exceptions and verifies Medicare via online tools
• Sends Journey Book tasks or emails regarding administration exceptions, benefits changes, coverage termination, and pre-certification requirements
• Advises leadership of updates needed to insurance verification alert list and noticeable insurance trends
• Reports to the Advocate, Patient Access Supervisor and communicates daily with multiple internal stakeholders

Insurance Verification Specialist

Analyst

• Design, build, and test an assigned Epic module
• Maintain documentation of business and system configuration requirements
• Configure the Epic software according to decisions made by SMEs such as templates, drop-down boxes and pick lists
• Complete assigned team tasks as documented in the work plan and report status to assigned Team Lead
• Provide timely alerts about endangered milestones and deliverables
• Analyzes, develops, configures, tests and implements Electronic Health Record (EHR) software and related analytics
• Performs system configuration functions using on-line architectural tools and coordinates system installation with user departments
• Prepares detailed program specifications and flowcharts; prepares charts and diagrams to assist in problem analysis and submits recommendations for solutions
• Acts as user liaison between clinical or business departments and Information Systems; provides domain expertise for multiple healthcare departments
• Works closely with operational stakeholders to properly engineer workflow and leads others to adhere to best practices

Insurance Verification Specialist

Senior Clinical Applications Analyst