Insurance Verification Representative

Vail Health has become the world’s most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here. Some roles may be based outside of our Colorado office (remote-only positions). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, FL, GA, ID, IL, KS, MA, MD, MI, MN, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift. About the opportunity: This role is responsible for the accurate and timely verification of insurance and benefits information for patients at Vail Health. The position plays a key role in the organization’s financial health by facilitating financial clearance prior to service and ensuring patient demographic and insurance information are correct, resulting in accurate claims. What you will do: Utilize online systems, phone communication, and other resources to determine eligibility and benefits within a timeframe before scheduled appointments determined by Vail Health. Accurately identify and assign payer plan codes in organization’s electronic health record system. Verify medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicate relevant coverage and eligibility information to the patient. Communicate with patients, physicians, clinicians, front-end staff, and translators to obtain any necessary additional information. Identify and obtain missing patient demographic, insurance, or pre-authorization information by effectively communicating with patients, physicians, clinicians, front-end staff, and translators. Coordinate benefits by effectively determining primary and secondary liability when needed. Obtain pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements. Alert patients or physician offices to issues with verifying benefits or eligibility; escalates complex cases as needed. Communicate patient liability directly to patients or to staff members who may discuss payment and financial assistance options with patients. Model the principles of a Just Culture. Perform other duties as assigned. Must be HIPAA compliant. This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. What you will need: Experience: One year of customer service experience preferred. Insurance verification or healthcare experience preferred. License(s): N/A Certification(s): N/A Computer / Typing: Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Experience supporting Windows servers required. Must have working knowledge of the English language, including reading, writing, and speaking English. Education: Degree in healthcare administration or related field preferred. Benefits at Vail Health (FullTime) Include: Competitive Wages & Family Benefits: Competitive wages Parental leave (4 weeks paid) Housing programs Childcare reimbursement Comprehensive Health Benefits: Medical Dental Vision Educational Programs: Tuition Assistance Existing Student Loan Repayment Specialty Certification Reimbursement Annual Supplemental Educational Funds Paid Time Off: Up to five weeks in your first year of employment and continues to grow each year. Retirement & Supplemental Insurance: 403(b) Retirement plan with immediate matching Life insurance Short and long-term disability Recreation Benefits, Wellness & More: Up to $1,000 annual wellbeing reimbursement Recreation discounts Pet insurance Pay is based upon relevant education and experience per hour. Hourly Pay: $21.32—$25.40 USD Apply To This Job