PBS Insurance Verification Technician - CO

Coordinate insurance eligibility and benefits in accordance with state and federal regulations; obtain authorizations or pre-certification for services provided, and/or determine if patient has no insurance coverage. Work closely with front end to resolve issues regarding terminated coverage (all insurance coverage, not limited to Kaiser), identify Medicaid eligibility, charity care and other insurance coverage as necessary. Other related duties may be assigned.

• This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.


• Identify and verify primary and secondary insurance coverage for all new and existing patients and/or determine if the patient has no eligibility or coverage on the date of service.


• Employee is responsible for assessing where work flow improvements are necessary and communicate such recommendations to the appropriate supervisor.


• The employee will ensure that he/she follows departmental and Regional policies and procedures.


• Fills in for absent employees and assists employees with large workloads as needed.


• Creates guarantor accounts, adding and removing account coverage.


• Working from several spreadsheets/logs and update systems.


• Complete multiple workque assignments (as assigned daily).


• Add workers compensation related claim information to registration.


• Identify Coordination of benefits for commercial payors and update account status.


• Works closely with other departments to identify insurance coverage and determine eligibility.


• Submit Medicaid and Commercial Prior Authorization request for medical treatment and complete follow up work.


• Receive inbound calls from members related to billing questions.


• Make outbound calls to insurance companies, members and other health care providers for eligibility inquiries.


• Identify visiting members, create medical record number and add coverage for all future appointments.


• Special Projects may be assigned.