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Revenue Integrity Coverage Representative 🔥

Overview: Inbound Call Center Pre-Registration
Verifies insurance eligibility, benefits and correct Guarantor set up for hospital based encounters, clinic based encounters and other registration based encounters. Performs initial set up, corrections and updates to accounts in order to ensure accurate information for claims processing.
Tuesday - Friday 6 hours a day Responsibilities/Job Description:
  • Primary responsibility is answering inbound pre-registration calls
  • Responsible for working assigned work queues on a daily basis and maintaining established quality and productivity goals
  • Responsible for the insurance verification of various visits; elective, emergent, urgent, and inpatient. Including but not limited to determining and documenting deductible, co-pay, and coinsurance.
  • Verifies coverage, Filing order, patient liability, correct account set up, and guarantor for patient encounters and visits.
  • Completes/corrects the set- up of insurance information. Verifies insurance eligibility through RTE as well as through numerous web based tools including insurance websites and calling insurance companies and adjusters.
  • Responsible for taking incoming internal and external customer calls, as well as making outgoing customer calls when necessary.
  • Participates in improvement efforts and initiatives that support the organizations goals and vision.
  • Responsible for communicating any insurance changes and issues with the Manager or site as directed.
  • Notifies designated financial resource of inadequate insurance coverage so that appropriate financial arrangements can be made.
  • Subject matter experts on Payor Grids, Changes and Payor plan IDs.
  • Required:
  • High school diploma or GED equivalent
  • Three or more years of healthcare experience
  • Call Center Experience
  • Preferred:
  • College degree in business or healthcare related fields
  • Proficient in MS office products
  • Experience in the healthcare industry preferred
  • One year of working with patient complaints or disputes

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