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PFS Enterprise Ins Verifier

Inova Health System
medical insurance
United States, Virginia, Fairfax
8095 Innovation Park Drive (Show on map)
Jan 06, 2025
The Patient Financial Services (PFS) Enterprise Insurance Verifier is responsible for representing Inova Health System to physicians/patients while assisting both to gain access to services across the enterprise. Supports Inova, individual operating units, patient registration and patients/physicians by working timely to ensure patients' healthcare benefits are verified and cover the required procedures. Maintains current knowledge of and adhering to payer/regulatory guidelines for medical insurance claims processing and reimbursement. Understands and upholds the basic philosophies of the Revenue Cycle, Accounts Receivable and Patient Accounts. Communicates effectively and works cooperatively with others while showing respect for and an understanding of other registration disciplines. Job Responsibilities Maintains productivity and accuracy standards as measured by work list completion, observation, and quality assurance. Serves as a Liaison between physicians, patients, and insurance to ensure all elective scheduled patients obtain authorizations. Ensures all precertification/authorizations are obtained timely. Enters amounts so payment arrangements can be made prior to the point of service. Performs verification of benefits, electronically or by telephone, according to department procedures/guidelines. Makes appropriate referrals to the self-pay team for County Medicaid, Non-County Medicaid, Emergency Medicaid, SLH, IHCTF, IFH, and/or MediCredit. Complies with department procedures and regulatory guidelines for Medicare Secondary payroll and ABN. Follows coordination of benefits and Medicare Secondary Payer guidelines to determine primary and secondary payer status. Follows department procedures for practice management documentation standards and updating accounts in Epic. Identifies and obtains required precertification, authorizations, and/or referrals while entering all information into the appropriate registration and billing system(s). Creates estimates through Carepricer for all scheduled elective patients. Completes the appropriate due diligence for each account when speaking with patients and follows Inova Health System's approved script as a guide regarding what to say and what not to say to patients. Identifies payment source and secures all information required to ensure a billable and collectible account while avoiding penalties, denials, and/or bad debt write-offs. May perform additional duties as assigned. Additional Requirements Experience - Three years of previous experience working in a hospital or healthcare facility in registration, patient accounts or physician billing office required; OR a combination of experience/education; (AA Degree = one year; Bachelor's Degree = two years) Education - High School or GED