Insurance Verification Specialist (On-site)

General Summary: To ensure patient insurance coverage is accurately recorded in the practice management system. Systematically review all appointed patients to ensure accurate coverage and communicate concerns related to inactive coverage, errors, alerts or not contracted plans to relevant Gonzaba Medical Group (GMG) team members. Review discrepancy reports routinely for patients that are new to the practice or who do not have scheduled appointments to ensure that accurate insurance coverage is maintained for all patients. Serve as subject matter expert related to GMG health insurance contracted plans and insurance coverage. Answer questions or concerns from GMG team members on a routine basis. Communicate concerns to clinical leadership to streamline the arrival and registration process for all patients in a GMG clinic.

Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements:  All duties performed will be done accurately and in a timely manner.

1. Work closely with all managers and/or designated person regarding issues with insurance.
2. Advise Manager of any pending issues or possible issues.
3. Serve as subject matter expert on GMG contracted and non-contracted insurance plans.
4. Bilingual (Spanish/ English) fluency preferred.
5. Ability to complete efficient and accurate data entry at a computer terminal.
6. Develop and maintain supportive, productive, and effective relationships with external and internal partners.
7. An understanding of Medicare, HMO, PPOs, and a clear understanding of the difference between all benefit packages.
8. Must have excellent written and verbal communication skills.
9. Strong attention to detail and exceptional organizational skills.
10. Maintain strict confidentiality.
11. Other duties as assigned.

Essential Job Responsibilities:

1. Collects, verifies, and enters demographics and insurance information into the various systems on new and established patient accounts for scheduled appointments.
2. Collects, verifies, and enters demographics and insurance information into the various systems for new or established patient accounts who may have a discrepancy in coverage between health plan and GMG system, but not contain an appointment.
3. Obtains insurance information necessary for various clinical services or procedures.
4. Creates reporting to clinical departments regarding appointments that may be problematic or that contain errors prior to patient appointment.
5. Reviews portals, instant message feeds and reports for inquiries related to patient insurance information and responds completely and timely.
6. Verifies patient eligibility and benefit package information via phone or online resources.
7. Obtains and documents in GMG system patient’s financial responsibilities to include co-payment, deductibles and any relevant information related to the patient’s insurance coverage such as PCP and or contracted status.
8. Make appropriate notations in the system regarding actions taken and insurance verification and authorizations.
9. Create and or maintain lists of GMG contracted insurance plans and distribute them to relevant departments.
10. Review reports to ensure all appointed patients listed are reviewed prior to patient appointment date.

Education and Training: Minimum high school education or equivalent required.

Experience: General office or customer relations work preferably in a medical group of large group practice minimum of two years’ experience preferred.

Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: Depending upon the area assigned may be 100% clinical setting or office setting in a clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.