Insurance Verification Analyst

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? Summary: Under general supervision, the Insurance Verification Analyst is responsible for obtaining insurance pre-certification. Responsible to obtain referrals required for scheduled surgeries, procedures and diagnostic appointments. Update insurance information to ensure accurate and timely reimbursement. Responsibilities: Performs follow up on assigned third party accounts for scheduled surgeries and diagnostic appointments.Follow up includes but is not limited to verifying eligibility, obtaining benefits, ensuring referrals, pre-determination and/or authorization requirements have been completed. Utilizes web based applications and or internet resources to follow up on outstanding items. Contacts insurance companies, physician offices, and patients as needed to verify coverage and authorization within established guidelines. Processes correspondence from insurance companies, case management and other departments within specified time limit. Provides patients with an estimate of their out of pocket expenses and attempts to collect payment and/or offers payment plan arrangements prior to visit. Determines and appropriately documents out of pocket responsibility for services as related to insurance contracts or PMPHFee Schedules (i.e. Self Pay Fee Schedule, Cosmetic Surgery List). If necessary refers patient to Financial Counselor for financial assistance. Follows established department protocols to communicate rescheduling/cancellation of scheduled surgeries, procedures and appointments if authorization is not obtained prior to date of service. Reviews Verification Work queues to ensure that authorization and/or referrals are obtainedas per the established timelines of the department Works in collaboration with other departmental associates as well as other hospital associates supporting their efforts though teamwork and the acceptance of additional assignments. Is able to accurately and consistently interpret and readily explain various healthcare insurance plans coverage, benefits and patient payment responsibilities. Education or Equivalent Experience: H.S. Diploma/GED (Required) At least two (2) years' experience working with healthcare insurance Bachelor of Arts or Science Vocational / Technical School / Diploma Program preferred Associate of Arts or Science Associate's Degree preferred We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

Created: 2024-10-28