Medical Insurance Specialist (per diem)

The Medical Insurance Specialist is responsible for insurance verification and other tasks pertaining to the maintenance of coordination of benefits for contracted plans. The Medical Insurance Specialist is responsible for updating member eligibility information on software programs to ensure that other departments have current and accurate data.

Professional Duties

• Process internal eligibility, Medicare Secondary Payer (MSP), and Coordination of Benefits (COB) requests.
• Maintain patient contact information updated in applicable internal software programs/applications.
• Contact members to confirm employer group status and establish coordination of benefits or Medicare Secondary Payer status.
• Verify member eligibility and update information on applicable internal software programs/applications.
• Review coordination of benefit information listed in the provider portals and make necessary updates on applicable internal software programs/applications.
• Participate in conference calls with Centers for Medicare Medicaid Services (CMS) and member to report MSP updates.
• Contact employer groups as necessary to establish MSP and/or COB.
• Assist with Health Plan (HP) batches, as needed.
• Other duties as assigned.
• Be knowledgeable about your job so that you can serve others effectively
• Be an active listener (make eye contact, validate)
• Be accountable for your work
• Validate to ensure understanding
• Demonstrate appropriate body language and tone of voice

Qualifications

• High School Diploma or equivalent.
• 3 years of experience in managed health care setting.
• Knowledge of health plans, government funded plans, and Department of Managed Healthcare COB guidelines.
• Ability to utilize computer and other office equipment. Knowledge of Microsoft Office programs (Word, Excel, Power Point, etc.)
• Ability to effectively communicate with individuals within all levels of the organization, members and others.
• Excellent customer service skills.
• Detail oriented and organizational skills. Ability to reprioritize tasks to meet established deadlines.
• At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.

Physical Demands

• Sitting: Approximately 95% of day
• Standing: Approximately 5% of day
• Walking: Approximately 5% of day
• Hearing/Visual Acuity: Adequate for use with computer and telephone

Approx 95% of day

• Computer: Highly technical work environment - Must be able to work >7 hours/day using keyboard, mouse, and monitor.
• Reaching: Above head 75 degrees - approximately 10%.
• Hand grip dexterity: Approximately 95% of day