Position Summary

The Insurance Verification Specialist ensures patients are appropriately financially cleared for all appointments. Performs eligibility verification, obtains pre-cert and / or authorizations, clears registration errors and edits pre-bill, and performs other duties as required.

Maintains a close working relationship with the clinical department to ensure continual open communication.

Work Hours / Shift : Must have availability Monday-Friday 8am-5pm

Travel : None

Responsibilities

• Proactively contacts insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance eligibility and benefits and determine extent of coverage within established timeframe before scheduled appointments and during or after care for unscheduled patients
• Meet department standard when obtaining pre-authorizations from third-party payers in accordance with payer requirements and within established timeframe before scheduled appointments and during or after care for unscheduled patients.
• Maintain close working relationship with clinical partners and referring offices to resolve issues with obtaining pre-authorizations.

Conducts diligent follow-up on missing or incomplete pre-authorizations with third-party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as needed

• Minimizes duplication of patient records by using problem-solving skills to verify patient identity through demographic details
• Ensures patient accounts are assigned the appropriate payor plans
• Ensures all financial assessments, eligibility, and benefits are updated and thorough to support post care financial needs.

Uses utmost caution that obtained benefits, authorizations, and pre-certifications are correct and as accurate as possible to avoid rejections and / or denials.

Maintains a current and thorough knowledge of utilizing online eligibility pre-certification tools made available

• Thoroughly documents all conversations with patients and insurance representatives - including payer decisions, collection attempts, and payment plan arrangements
• Adheres to HIPAA regulations by verifying information to determine caller authorization level receiving information on account.
• Creates accurate estimates to maximize up-front cash collections and adds collections documentation where required
• Calculates patients? co-pays, deductibles, and co-insurance. Provides personalized estimates of patient financial responsibility based on their insurance coverage or eligibility

Requirements

• Always maintain the highest level of confidentiality to HIPAA standards.
• Must be detail oriented in order to maintain good financial practices, account balances, and financial reporting.
• Good mathematical aptitude
• Ability to multi-task in a stressful deadline-oriented environment.
• Ability to communicate with coworkers, providers and patients in an effective manner.
• Good organizing, coordination and office skills
• Customer service orientation and good phone etiquettes
• Must be flexible and understand that job duties may change from time to time and that this individual may be asked to assist in other areas of the office.

Last updated : 2024-04-27