Description

JOB SUMMARY

The Insurance Verification Specialist is responsible for verifying patient eligibility and insurance plan benefits. The Insurance Verification Specialist will verify coverage via insurance carrier online portal, contacting carrier directly and document findings on patient Electronic Medical Record (EMR).

DUTIES AND RESPONSIBILITIES

• Verify insurance eligibility for upcoming appointments by utilizing online websites or by contacting the carriers directly.
• Determines patient co-payments and calculates co-insurance and deductibles.
• Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient Electronic Medical Record (EMR).
• Assist front office with verification questions or concerns.
• Obtains authorizations for procedures that require approval, as well as following up on pending authorizations.
• Communicates insurance coverage with the patient and the staff.
• Resolves any coverage issues and update patient Electronic Medical Record (EMR).
• Investigates and verifies insurance coverage and eligibility for scheduled services.
• Creates and collects patient out of pocket estimates.
• Financial clear office visits that may involve minor procedures for specialist services.
• Contacts external PCP offices to initiate and secure insurance PCP referral approvals for specialists.

Qualifications

REQUIREMENTS

• High school diploma or GED.
• Some College, Associate’s Degree or higher preferred.
• Minimum two years' medical office experience.
• Bilingual preferred not required
• Intermediate PC Skills, MS Suite
• Ability to work utilizing Phone, Email-Outlook
• One year of relevant experience in Acute Care setting.
• Multi-Specialty insurance verification experience.
• Pre-service verification experience is preferred.
• Epic or similar experience preferred.

EDUCATION

• High school diploma or GED.
• Some College, Associate’s Degree or higher preferred.
• Minimum two years' medical office experience.
• One year of relevant experience in Acute Care setting.
• Multi-Specialty insurance verification experience.
• Pre-service verification experience is preferred.
• Epic or similar experience preferred.

CERTIFICATION, LICENSURE

• N/A

KNOWLEDGE SKILLS & ABILITIES

• Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations
• Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization.
• Ability to stay focused in a fast-paced environment, manage time efficiently, and able to multitask.