Insurance Verifier- Business Office

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

Under the general direction of the ASC Business Office Manager, the ASC Insurance Verifier verifies patients' insurance eligibility, benefits, requirements specifically related to the service scheduled. Determines patient co-payments and calculates co-insurance and deductibles for both facility and professional services. Fully utilizes the practice management system's eligibility media, payer on-line portals, telephone IVR, and person to person contact to most efficiently obtain pertinent information.  Responsible for communicating with the clinic and/or patient, any information that will be needed prior to or during the patients visit.  Meets productivity and quality standards.

Primary Responsibilities:

• 40% Departmental Responsibilities 
  • Ensure the accuracy of all account demographic insurance and billing information set up in the computer system 
  • Review surgery schedules and EPIC Work queues for patient accounts requiring financial review 
  • Initiate and complete insurance verifications in a minimum of three days in advance of scheduled surgery for add-on cases and optimally 2 weeks in advance for all other cases 
  • Obtain necessary authorizations/precertification as required at least three days in advance of scheduled surgery for add on cases and optimally 2 weeks advance for all other cases 
  • Uses the most efficient means available to obtain insurance eligibility and benefits using the Practice Management system, payer websites or by phone, as applicable 
  • Calculate facility and professional component patient responsibility based on patient benefits obtained, current managed care contract allowable and CPT code order, if applicable 
  • Input all patient demographic/insurance and   information obtained in the course of the verification into computer system in accordance with established procedures 
  • Link referrals and create claim information, enter applicable claim numbers and precertification authorization numbers 
  • Link hospital encounters in registration  
  • Record all benefit information in patient CRM's 
  • Promptly direct any problems or questions with regard to verification process to the department Lead or Business Office Manager 
  • Update new address information into computer system   
  • Update and follow-up with physician secretary (DSS) regarding coding or scheduling changes to ensure accurate UR issued  
  • Reconcile verified appointments to current surgery schedule to ensure no missed patient verifications 
  • Mail out patient benefit letters daily, if applicable 
  • Keep abreast of new managed care contracts and specific payer requirements   
  • Keep department Lead/Business Manager informed on status of activities. 
  • Assist with other duties as requested by Management 
• 30% Customer Service 
  • Demonstrate a polite, courteous, and friendly manner at all times with all internal and external customers and coworkers 
  • Display superior communication with interdepartmental teams including UR department, departmental secretaries, nurses and physicians 
  • Initiate payment arrangements with patients with difficulty meeting financial obligation when appropriate 
  • Inform Team Lead or Business Office Manager if a patient is unable to meet financial obligations.    
  • Resolve issues via phone related to patient obligations when patient has arrived at front desk  
  • Assist other office personnel with managing heavy phone traffic as requested 
  • Communicate with insurance companies and other third parties in a professional, courteous manner 
  • Demonstrate Kelsey-Seybold Mission and Values 
• 20% Productivity And Quality 
  • Meet or exceed verification quality standards 
  • Meet or exceed verification productivity standards 
• 10% Other duties as assigned 

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High school diploma, or GED
• 1+ years of experience in a fast-paced medical office or facility setting with patient registration, appointment scheduling or medical billing experience
• 1+ years of experience with medical insurance verification
• Knowledge of managed care
• Knowledge of health insurance types and terms
• Familiarity using CPT, ICD-9 and HCPCS coding
• Basic PC literacy and ability to navigate the Internet
• Good mathematical skills to include ability to apply percentages
• Demonstrated good customer skills
• Demonstrate fast and accurate computer and data entry skills
• Demonstrated effective communication skills
• Demonstrated ability to speak, hear, write, and read clearly

Preferred Qualifications:

• Some College
• 3+ years of experience in a fast-paced medical office or facility setting with patient registration, appointment scheduling or medical billing experience
• 3+ years of experience with medical insurance verification and authorizations
• Experience using Epic software system
• Comprehensive knowledge of managed care
• Familiarity using CPT, ICD-9 and HCPCS coding in a facility setting
• Demonstrated excellent customer service skills
• Bilingual (English/Spanish)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.