EMPLOYEE

JOB DESCRIPTION AND

PERFORMANCE  EVALUATION

Employee Name:

Date:

Position Title:

Insurance Verification Clerk

Department:

Patient Billing Office

Manager:

Patient Business Office Manager

Reviewing Period Of

Standard

Defined By

Always

Frequent

In

Frequent

Never

SERVICE

-Responds to customer needs, regardless.

Makes immediate eye contact, acknowledge other with a smile.

Makes a “positive first impression” a top priority.

Responds to difficult situations with self control and a positive attitude.

Demonstrates “service recovery” behaviors, as appropriate.

Makes sure others are satisfied with results.

PERFORMANCE

-Achieves excellence.

Exceeds expectations of supervisor, co-workers, and patients.

Displays sensitivity to any inconvenience others may encounter.

Shows appreciation by saying “thank you.”

Makes “excellence” the goal in all endeavors.

Ensures a safe environment for all others.

INTEGRITY

-Lives the values and Mission Statement.

Separates “personal” issues from work.

Respects, honors & demonstrates confidentiality of patient information. HIPAA

Does not talk of job related issues to or in front of patients and others.

Displays and encourages a positive image and attitude.

Demonstrates neat appearance and appropriate dress, wears ID badge.

RESPECT

-Honors all individuals.

Listens first, does not jump to conclusions or pre-judge situation.

Acknowledges the perception of others.

Appreciates and respects differences in opinions and approaches.

Acknowledges customer immediately. Make’s them feel welcome.

Knocks on doors before entering. Fully explains intentions to others.

INNOVATION

-Improves constantly.

Strives to turn a negative situation into a positive outcome.

When doesn’t know the answer, find’s someone who does.

Accepts change and contributes to the change effort.

Effectively utilizes resources to minimize costs.

When assigned work is complete, seeks additional tasks.

TEAMWORK

-Trusts and cooperates.

Communicates effectively and courteously.

Takes the initiative to help others.

Treats all staff as members of one cohesive team.

Holds each other accountable for the success of the team.

Respects team by being at work on time and demonstrating regular attendance.

SECTION “A” TOTAL

TITLE:

Insurance Verification Clerk

FLSA STATUS:

Non-Exempt

DEPARTMENT:

Patient Billing Office

REVIEW DATE:

REPORTS TO:

Patient Business Office Manager

Works under general supervision performing complex duties following established procedures.  Responsible for screening and verifying patient information; researches patient accounts and reclassifies Medicaid charges as necessary; and maintains appropriate records.

RESPONSIBILITY

Always

Frequent

In

Frequent

Never

1.

Knowledgeable of Medicaid/Medicare eligibility requirements in order to assist patients with effective utilization of resources.

2.

Initiates intake process to determine patient insurance information.  Update, add, or delete flags in HealthPro as necessary.

3.

Makes two copies front and back of insurance cards, including: Medicare, Medicaid, private insurance, PPO’s, traditional insurance, and pharmacy cards.  Send one copy to Medical Records and keep one copy for Patient Billing.

4.

Complete insurance verification form for private insurance patients, PPO’s and traditional insurance, then make a copy for Patient Billing.

5.

Directs SoonerCare/Medicare eligible patients to the Eligibility Department as necessary.

6.

Utilizes OHCA website and verifies all Medicaid eligible patients and Primary Care Physicians. 

7.

Performs Medicaid data entry. Reclassify pay codes in HealthPro as needed. Utilizes and maintains reclassification reports in addition to sending copies to Patient Billing.

8.

Data entry of pharmacy insurance cards into Pharmacy and Healthpro billing systems and add to daily log to be given to Patient Account Clerk.

9.

Prepare all required insurance verifications, IHC or departmental reports.

10.

Complies with all AAAHC standards and requirements such as annual TB test, CPR and CEU if applicable.

11.

Interacts and communicates with fellow staff in a way that promotes a harmonious and cooperative working environment.

12.

Complies with all safety rules and regulations. Follows proper safety procedures and utilizes proper protective equipment at all times.

13.

Displays strong written and oral communication skills.

14.

Exhibits maturity and the ability to deal effectively and professionally with patients and staff.

15.

Displays a “customer first” approach to problem solving.

16.

Maintains current knowledge of, and participates in, compliance efforts associated with the Government Performance Results Act (GPRA). Captures data as appropriate.

17.

Performs other duties as assigned.

SECTION “B” TOTAL

Knowledge, Skills, Abilities

High school graduate or equivalent.  Two years of college with equivalent experience in work as an insurance clerk, eligibility worker, or social worker in a medical office environment.

CPR certification.

Intermediate computer skills.  Proficient in MS Office and/or applicable software programs.

Strong written and oral communication skills.  Excellent interpersonal skills.

Ability to multi-task and work independently, demonstrating initiative and accuracy in work results.

Working Conditions

Mostly sedentary.  Must be able to sit in a chair most of the day to do the work.  Must be able to maneuver the body while sitting and using a computer keyboard. Minimal standing, walking, bending, carrying of light items (up to 15 pounds) such as papers, books, files, and lifting of mail baskets and office items.

ACCOMPLISHMENTS:

AREAS NEEDING IMPROVEMENT:

GOAL’S FOR UPCOMING YEAR: