Position Summary

This position is responsible for centralized benefit verification, insurance criteria management, referral and appeal coordination. Insurance Specialists are liaisons between insurance companies, members and patients, providing benefit communications on each member who seeks medical treatment.

Responsibilities

• Ensures accurate benefit verification of all health insurance coverage for each member scheduled for a medical appointment.
• Contact member’s health insurance company to attain referral authorizations.
• Coordinate appeals on behalf of members/providers requesting services be covered under member’s health insurance.
• Organizes requirements and acts as liaison between providers and insurance companies to ensure member’s insurance criteria are met.
• Patient service via telephone and emails.
• Maintains confidentiality of member and patient related business.
• Follows established department/organization policies and procedures.
• Documents concisely, precisely, and accurately on all documents as indicated by department processes and organizational policies.
• Develops and maintains an effective working relationship with members, patients, insurance companies and staff.
• Maintains and increases standards of performance and education.
• Completes required continuing education standards as directed by Company/Management.
• Regular, physical attendance on a predictable basis is essential to the performance of this job.
• Assists in both day-to-day and special projects and performs other duties as assigned.

Knowledge, Skills and Abilities

• Proficient knowledge of phone systems, the 10 key calculator, facsimile processes, computers, copiers, scanners, Microsoft Outlook, Word and Excel.
• Language/Communication skills: must be able to read and interpret medical record documentation, and policy and procedures.
• The ability to work concurrently on multiple projects with varying priorities. Works well under pressure and within deadlines, and gives great attention to detail.
• Patient and Personal Service. Knowledge of principles and processes for providing patient and personal services. This includes patient needs assessment, meeting quality standards for services, and evaluation of patient satisfaction.
• Reading Comprehension. Understanding written sentences and paragraphs in work-related documents. The ability to read and understand information and ideas presented in writing/type.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Ability to work independently/self-motivated, highly organized.
• Time Management. Managing one’s own time and the time of others. Ability to be flexible with schedules and duties; including, willingness and ability to work overtime.
• Excellent judgment and creative problem solving skills. Self-reliant, good problem solver, results-oriented.