Insurance Verification Representative - Tennova Heart ...

Insurance Verification Representative - Tennova Heart Turkey Creek The Insurance Verification Representative is responsible for accurately verifying patient insurance coverage, benefits, and eligibility to ensure proper reimbursement and prevent service delays. This role coordinates with physician offices, case management teams, and financial counseling to facilitate pre-certifications, authorizations, and patient financial obligations. The Insurance Verification Representative plays a key role in maintaining accurate patient account liability, minimizing denials, and improving revenue cycle efficiency. Essential functions include verifying insurance benefits, eligibility, and pre-determination requirements for all scheduled patients, ensuring accuracy and completeness before services are rendered. The representative coordinates with physician offices to obtain required pre-authorizations and pre-certifications, preventing reschedules or cancellations due to missing approvals. They confirm patient coverage for procedures and treatments, documenting insurance details, policy limitations, and reimbursement expectations. Additionally, they initiate financial counseling for uninsured or underinsured patients, referring them to financial assistance programs or payment plan options. Accurate documentation and updates to patient records, including pre-certification numbers, eligibility details, and authorization statuses, are also part of the role. Effective communication with patients and physician offices, providing clear information regarding insurance coverage, financial responsibilities, and payment expectations, is crucial. The representative ensures timely entry of pre-registration documents into the electronic health record (EHR) and forwards them to the appropriate department. They maintain accurate department records, reports, and documentation, ensuring compliance with billing, regulatory, and facility policies. The role also involves identifying and resolving insurance discrepancies, proactively addressing issues that could result in billing errors or claim denials. Collaboration with case management, patient registration, and billing teams is essential for seamless revenue cycle operations and optimized reimbursement. Qualifications include 0-2 years of experience in insurance verification, medical billing, or patient access in a healthcare setting. Experience with electronic health records (EHR), insurance portals, and revenue cycle workflows is preferred. Knowledge of insurance verification, pre-authorizations, and patient financial services is necessary, along with proficiency in healthcare insurance terminology, including co-pays, deductibles, out-of-pocket costs, and covered services. Ability to interpret and apply insurance policies and payer guidelines to verify eligibility and benefits accurately is required. Effective communication and customer service skills, ensuring professional interactions with patients, physician offices, and insurance providers, are essential. Strong organizational and time-management skills, handling multiple verification requests efficiently, are also needed. Understanding of HIPAA regulations and patient privacy requirements when handling sensitive financial and insurance information is crucial.

Created: 2026-03-04