Insurance Validation Administrator

at  Beacon Hospital

EXPERIENCE

• Computer literate.
• Experience using IT systems, including MS Excel & Word.
• Previous experience working with private medical insurance processes.
• Previous experience in a customer facing administrative role.

JOB SPECIFIC COMPETENCIES AND KNOWLEDGE

• Exhibits high level of customer / patient relation skills.
• Complies with processes and procedures
• Exhibits ability to work as member of team in daily performance of duties.
• Have a high capacity for responsibility and individual initiative.
• Able to communicate using clear and concise English.
• Have excellent organisational skills.

OVERALL PURPOSE OF JOB

Our mission is to provide exceptional patient care in an environment where quality, respect, caring and compassion are at the centre of all we do.
The overall purpose of this role is to verify patient health insurance entitlements in advance of their treatment/procedure in the Beacon Hospital and to communicate to patients and staff any balances owing.

KEY RESPONSIBILITIES AND DELIVERABLES

• Responsible for timely verification by phone or using electronic verification systems that patients have valid private health insurance.
• Obtain complete record of each patient’s relevant history of illness and insurance coverage to determine that any pertinent waiting periods have been served.
• Identify the level of each patient’s private health insurance cover and accurately calculate any excesses, shortfalls or co-payments owing.
• Ensure timely communication to patients to explain the extent of insurance coverage provided by their insurance policy and clearly set out any financial obligations to the hospital they may have.
• Calculate charges owing for self-paying patients and communicate these to the patient.
• Enter all insurance information accurately into the hospitals MEDITECH system.
• Document activity in the patients account in a timely manner with relevant, clear and precise information.
• Ensure that patient confidentiality and other Hospital policies regarding data protection are adhered to.
• Maintain up-to-date knowledge of insurance contracts and plans as they change.
• Provide expert validation support and advice to other service areas undertaking validation activity, e.g. ED; Radiology.
• Coordinate with the Business Office team regarding issues or concerns regarding patients’ accounts.
• Handle incoming and outgoing calls from other staff members, Health Insurers and patients related to insurance benefits and charges in a courteous, timely and professional manner.
• Demonstrate a positive attitude that is supportive of your colleagues and manager in delivering the best service to patients and visitors.
• Maintain a neat and tidy work area.
• Assist in the training and development of new employees.
• Be open to new learning opportunities and adaptable to change.
• Assist in dealing with and recording complaints in an effective and courteous manner.
• Ensure the Supervisor/Manager of the area is made aware of any complaints.
• Identify and escalate priority issues referring to the Supervisor or Manager if necessary.

PERSONAL AND PROFESSIONAL RESPONSIBILITIES:

The post holder is expected to:

• Adhere to the Hospital’s mission and Vision
• Maintain patient confidentiality including authorisation of the release of medical information
• Abide by Hospital policies and all regulatory requirements including mandatory training
• Have excellent customer care and communication skills, both written and verbal
• Have excellent knowledge of computers and Microsoft Windows software and keyboard skills
• Have excellent time management skills and ability to multi-task and prioritize work
• Build collaborative relationships through strong teamwork across the organization
• Be flexible, reliable and detail orientated. Hours of work will on occasion be subject to change
• A willingness to change with the hospital requirements