Verification of Benefits

POSITION TITLE: Benefits Verification Specialist

Location; Fort Lauderdale Area

POSITION SUMMARY:

Under close supervision of the Management Team, the Benefits Verification Specialist will contact insurance companies, on behalf of the medical office, to verify patient-specific benefits. The Benefits Verification Specialist will ask appropriate questions regarding the patient’s benefits and complete data entry and/or appropriate forms to document the patient’s benefits coverage.

PRIMARY DUTIES AND RESPONSIBILITIES:

· Collects and reviews all patient insurance information needed to complete the benefit verification process.

· Verifies patient-specific benefits and precisely documents specifics for various payer plans including patient coverage, cost-share, and access/provider options according to specific SOPs.

· Verification process could include electronic validation of pharmacy coverage and medical eligibility.

· Identifies any restrictions and details on how to expedite patient access.

· Could include documenting and initiating prior authorization process, claims appeals, etc.

· Completes quality review of work as part of finalizing the product.

· Reports any reimbursement trends/delays to supervisor.

· Performs related duties and special projects as assigned.

· Ability to work in a fast-paced office environment.

· Work requires focus, flexibility, and the ability to adapt to changing work situations.

· This position requires that the Associate be seated most of the day.

Required:

· Proficient Windows based experience including fundamentals of data entry/typing

· Working knowledge of Outlook, Word, and Excel

· Strong interpersonal skills and professionalism

· Independent problem solver, good decision maker, and robust analytical skills

· Strong attention to detail

· Effective written and verbal communication

Preferred:

· High school diploma or GED minimally required. Two (2) years directly related and progressively responsible experience and/or college degree.

· Specific experience in medical office administration, benefit verification, coding, claims processing or customer service at an insurance company a plus

· Broader experience/training may be considered in fields such as case management, social services and pharmacy technician.

· Familiarity with verification of insurance benefits a plus.

· Fundamental understanding of key payers including Medicaid, Medicare and private payers

· Strong customer service experience

Exact Billing Solutions Culture

Exact Billing Solutions is a supercharged environment propelled by collaboration through our philosophy: “Empowering Your Ambition.” The expectation for each team member is to provide a highly supportive high-performance work environment. Exact Billing Solutions team members are charged with:

• Identifying challenges and collaborating with team members to devise creative solutions and measurable outcomes
• Motivating team members to be their best while holding them accountable to maintain the company’s excellent service standards
• Establishing and maintaining open and honest communication, always sharing information
• Continual learning, teaching and development
• Leading and driving initiatives to completion

Technology

Technology is an essential part of managing the needs of our business. Team members are expected to use the instruments and systems identified as efficient and effective methods to manage day-to-day operations in their role. We encourage feedback on new and emerging systems and/or instruments that may promote more efficiencies and better performance.

HIPAA

Team members are required to adhere to policies and procedures implementing HIPAA requirements for the privacy and security of protected health information. Team members are permitted to use and/or disclose only minimum amount of Protected Health Information necessary to complete assigned tasks.

Reports all suspected violation of company’s HIPAA policies or procedures to Human Resources.

Environmental Stewardship and Safety

• Team members are expected to adhere to facility safety requirements, report unsafe practices or equipment, and, if applicable, use the appropriate protective equipment as needed.
• Depending on role, and during the daily course of duties, team members may have to lift, twist, pull or push. Team members must be able to manage these activities up to 60 lbs.
• Any accident or incident must be reported immediately to a member of management for proper recording.

Candidates must meet the company’s hiring criteria to include a pre-employment background investigation and drug test. We are an Equal Opportunity Employer and a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

We offer a competitive compensation and benefits package including a base salary with performance-based incentives, medical, deal, vision, short/long-term disability, life insurance and 401(k).

Team Members excluded from Federal Healthcare Programs.

Exact Billing Solutions operates facilities that receive federal funding and may not employ or contract with an individual or entity that has been excluded from health care programs (for example, Medicare or Medicaid). Accordingly, if a team member or agent has been excluded from or is under investigation and may be excluded, they must notify a member of management immediately.