The Insurance Verification Specialist is responsible for initiating contact with insurance companies for verification and authorization of inpatient and outpatient services and ensuring timely and accurate insurance authorization.Specialist will also secure demographic and financial information prior to patient arrival.

Essential Job Duties and Responsibilities:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Conducts a complete benefits investigation on all scheduled cases to ensure a patient has valid insurance coverage prior to surgery.

2.Updates patient’s profile appropriately.

3.Places outbound calls to patients or physicians' offices to obtain additional information needed to obtain prior approval.

4.Communicates any referral delays or issues to the appropriate staff member.

5.Provides prompt and accurate information to departments affected by delays.

6.Operates office machines as required.

7.Collects insurance cards and authorizations from Business Office.

8.Duplicates and distributes materials as needed.

SUPERVISORY RESPONSIBILITIES:

N/A

OTHER DUTIES AND RESPONSIBILITIES:

Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job.Duties, responsibilities, and activities may change at any time with or without notice.

KNOWLEDGE, SKILLS, COMPETENCIES, QUALIFICATIONS and EDUCATION AND/OR EXPERIENCE REQUIREMENTS:

1.High School diploma or equivalent education required.

2.Medical terminology background required.

3.Candidate must have at least 2 years of experience with hospital insurance plans including Medicare, Medicaid, HMO's, and PPO's.

4.Excellent typing and computer skills

5.Familiarity with area managed care plans and contractual terms.

6.Strong interpersonal skills necessary.

7.Writing skills as well as good grammar, punctuation, and composition skills beneficial.

8.Ability to get along well with other people/coworkers/patients.

9.Ability to project a positive team attitude.

10.Steady attendance and flexibility in schedule.

11.BLS certification

PHYSICAL DEMANDS

1.Will be required to sit for extended periods of time.

2.Must possess and demonstrate critical thinking skills.

3.Dexterity: Frequent repetitive motion of hands/wrist involved.

4.Will be working in a clean, well-lighted area.

5.May be required to deal with unpleasant environmental situations resulting from patient care or patient activity.

6.Hazards and Risks: Direct patient contact with possible exposure to communicable diseases, exposure to radiation, anesthetic scavenger gases, and CRT.

USPI’S EDGE™ (Every Day Giving Excellence)

USPI’S EDGE™ is the key to the differentiation of USPI as a customer-focused company.The process of completing EDGE™ requirements establishes processes and measurements that are collected, assimilated, and shared throughout USPI.All employees are involved with EDGE™.The involvement can range from doing their jobs to taking on the role of gathering and/or entering data into the computer.All employees shall at some time during their employment be required to participate in the EDGE™ program.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996

Responsible for knowing the processes involved assuring the standards established by HIPAA, and ensuring they are followed including the practices and records relating to the use and disclosure of Protected Health Information.

WORK AUTHORIZATION/SECURITY CLEARANCE

Must be authorized to work in the United States.

AAP/EEO STATEMENT

Dunes Surgical Hospital is an Equal Opportunity Employer