Vail Health

Insurance

• Utilize online systems, phone communication, and other resources to determine eligibility and benefits prior to scheduled appointments in accordance with Vail Health timelines
• Accurately identify and assign payer plan codes in the organization’s electronic health record system
• Verify medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicate coverage and eligibility details to patients
• Communicate with patients, physicians, clinicians, front-end staff, and translators to gather any additional required information
• Identify and obtain missing patient demographic, insurance, or pre-authorization details
• Coordinate benefits by determining primary and secondary liability when applicable
• Obtain pre-certifications and pre-authorizations from third-party payers per payer requirements
• Escalate complex cases and notify patients or physician offices of any issues impacting verification or eligibility
• Communicate patient financial responsibility directly or partner with appropriate staff to review payment and financial assistance options
• Demonstrate and uphold the principles of a Just Culture
• Perform other duties as assigned; must remain HIPAA compliant

Insurance Verification Representative