North Knoxville Medical Center
Insurance Verification Representative - Tennova Primary Care North - Powell
Powell
,
TN
Full Time
Why Join Us?
No weekends, No holidays, No Call
Hours of Operation: Monday - Friday 8 to 4:30
Job Summary
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
- Be Valued for What You Bring to the Team - Competitive pay that rewards your hard work
- Benefits You Can Count On - Medical, dental, vision, and life insurance coverage
- Work Hard. Recharge Often. - Generous PTO and extended illness benefits
- Invest in Your Future - 401(k) with company match
- Grow With Us - Career development, learning opportunities, and advancement pathways
- We Invest in Your Success - Licensure and certification reimbursement
- Student Loan Support - Assistance available for eligible roles
- Your Wins Deserve Recognition - Employee rewards and recognition programs
- A Team You'll Love Working With - A collaborative, purpose-driven culture making a difference every day
- Additional Voluntary Benefits - Choose from options such as pet insurance, identity protection, and legal insurance.
No weekends, No holidays, No Call
Hours of Operation: Monday - Friday 8 to 4:30
Job Summary
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
- Verifies insurance benefits, eligibility, and pre-determination requirements for all scheduled patients, ensuring accuracy and completeness before services are rendered.
- Coordinates with physician offices to obtain required pre-authorizations and pre-certifications, preventing reschedules or cancellations due to missing approvals.
- Confirms patient coverage for procedures and treatments, documenting insurance details, policy limitations, and reimbursement expectations.
- Initiates financial counseling for uninsured or underinsured patients, referring them to financial assistance programs or payment plan options.
- Accurately documents and updates patient records, including pre-certification numbers, eligibility details, and authorization statuses.
- Communicates effectively with patients and physician offices, providing clear information regarding insurance coverage, financial responsibilities, and payment expectations.
- Ensures timely entry of pre-registration documents into the electronic health record (EHR) and forwards them to the appropriate department.
- Maintains accurate department records, reports, and documentation, ensuring compliance with billing, regulatory, and facility policies.
- Identifies and resolves insurance discrepancies, proactively addressing issues that could result in billing errors or claim denials.
- Works collaboratively with case management, patient registration, and billing teams, ensuring seamless revenue cycle operations and optimized reimbursement.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- 0-2 years of experience in insurance verification, medical billing, or patient access in a healthcare setting required
- 2-4 years of insurance verification experience in an acute care hospital or physician practice group preferred
- Experience with electronic health records (EHR), insurance portals, and revenue cycle workflows preferred
- Strong knowledge of insurance verification, pre-authorizations, and patient financial services.
- 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.
- Effective communication and customer service skills, ensuring professional interactions with patients, physician offices, and insurance providers.
- Strong organizational and time-management skills, handling multiple verification requests efficiently.
- Proficiency in electronic health record (EHR) systems, payer websites, and insurance portals for eligibility verification.
- Understanding of HIPAA regulations and patient privacy requirements when handling sensitive financial and insurance information.
- CHAA - Certified Healthcare Access Associate preferred