Insurance Verification Representative II - Central Insurance Verification Clinic Team

Position Title:

Insurance Verification Representative II - Central Insurance Verification Clinic Team

Department:

Admitting

Job Description:

The Insurance Verification Representative II is responsible for timely and accurate pre-registration, insurance verification, and patient demographic updates. This role ensures compliance with payor requirements and supports the revenue cycle through effective communication and documentation. This role serves as a lead within the department by performing advanced duties and assisting with staffing, quality assurance, reporting, and training.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Perform pre-registration and insurance verification for inpatient and outpatient services.

• Follow scripted benefits verification and pre-certification format in the EMR and document results.

• Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.

• Assign insurance plans accurately and perform electronic eligibility confirmation.

• Complete Medicare Secondary Payor Questionnaire as applicable.

• Calculate patient cost share and arrange payment or collection via phone.

• Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).

• Communicate with physicians and case managers to resolve authorization or referral issues.

• Document benefit and authorization information in the standard EMR screens and notes as needed.

• Implement system downtime procedures when necessary.

• Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.

• Lead daily operations and assist staff with complex insurance verification issues.

• Monitor and reconcile reports to ensure timely and accurate processing.

• Support QA processes and assist management with audits.

• Train new staff and provide ongoing guidance to team members.

• Serve as point of contact for escalated issues with physicians, insurance companies, and case managers.

• Ensure compliance with Medicare and other payor-specific rules and regulations.

• Maintain documentation standards in the EMR.

• Coordinate with hospital departments and facilitate communication across teams.

• Assist with staffing coverage and workflow prioritization.

• Perform special projects and other duties as assigned by management.

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General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications

Education Requirements

• High School Diploma or GED required.
  

Experience Requirements

• 3 or more years of experience in hospital Patient Access required.

License/Certification/Registration Requirements

• Certified Revenue Cycle Representative (CRCR) issued by the Healthcare Financial Management Association (HFMA) or Certified Healthcare Financial Professional (CHFP) issued by HFMA required within 180 days of hire.

Knowledge/Skills/Abilities Requirements

• Advanced communication and leadership skills.

• Strong analytical and problem-solving abilities.

• Proficiency in EMR systems.

• Ability to mentor and support team members.

• High level of accuracy and attention to detail.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.

About Us

OU Health is the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Health is home to Oklahoma’s largest doctor network with a complete range of specialty care. OU Health serves Oklahoma and the region with the state’s only freestanding children’s hospital, the only National Cancer Institute-Designated OU Health Stephenson Cancer Center, Oklahoma’s flagship hospital, which serves as the state’s only Level 1 trauma center and Edmond Medical Center in the heart of the Edmond Community. Becker’s Hospital Review named University of Oklahoma Medical Center one of the 100 Great Hospitals in America for 2020. OU Health’s oncology program at OU Health Stephenson Cancer Center was named Oklahoma’s top facility for cancer care by U.S. News & World Report in its 2020-21 rankings. OU Health also was ranked by U.S. News & World Report as high performing in these specialties: Colon Surgery, COPD and Congestive Heart Failure. OU Health’s mission is to lead healthcare in patient care, education and research.

Experts in prevention, treatment and cures, our team works to improve lives through innovation in medical care, education and research, while investing in the people, technologies and facilities that will enable us to achieve our goals. We are seeking individuals who have a passion and talent for caring for others. By joining our team, you will provide quality health care to our community through the work you do every day. We provide clinical and non-clinical opportunities to further your career and we invite you to explore our available positions.

Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity, genetic information or protected veteran status in accordance with applicable federal laws. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves of absence, compensation, and training. Reasonable accommodations are made to the known physical and mental limitations of qualified individuals with disabilities.