Insurance Verification Specialist (Bariatric Clinic)

Description

Position Summary: Insurance Verification Specialist is responsible for the pre-verification of insurance for patients being admitted into the hospital for care. Ensures insurance coverage, resolves any issues with coverage and escalates complicated issues to a supervisor or manager. Insurance Verification Specialist interviews patients and completes all paperwork necessary to ensure the admitting process is efficient and all hospital and regulatory policies are in compliance.

Essential Functions

• Accurately enter insurance information into computer system.
• Responsible for pre-certification/ authorization and insurance verification for all patients
• Research, follow up and resolve open & pending authorizations in a timely manner
• Calculate cash estimates for patients on upcoming visits/ procedures
• Concisely, precisely and accurately document all information.
• Maintain clear communication with patients as well as insurance companies.
• Obtain prior authorization for procedures.
• Scanning medical documents into patient accounts
• Demonstrates ability to effectively communicate (written and oral) with individuals and groups of various backgrounds and educational levels in a high stress environment.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner, under stressful demands while maintaining exceptional customer service.
• Reviews and processes patient registration forms and ensuring they contain all necessary documents.
  
  

Behavioral Standards

• Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; Expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints, and questions; displays a positive attitude.
  
  

Communication/Knowledge

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer’s and co-worker’s time; establishes and maintains effective relationships with customers and co-workers.
  
  

Collaboration/Teamwork

• Attends staff meetings; follows HIPAA guidelines; follows patient rights policy; complies with the compliance program; demonstrates knowledge of role in a disaster; demonstrates knowledge of fire and fire drill procedures; working knowledge of hospital emergency codes; always utilizes standard precautions in the clinical setting; safely manages the environment of care by demonstrating a working knowledge of the requirements of the: Life Safety program, Utilities Management program, Hazardous Materials program, Emergency Preparedness program, Safety Management program, Medical Equipment Management program, Security Management program.
  
  

Requirements

Experience:

• At least one (1) year of previous experience in a medical/ or surgery office setting
• Minimum one (1) year of previous experience with insurance verification and/or claims and denials.
• Basic knowledge of Medical Terminology
• Proficient computer and telephone skills
• Basic math skills
  
  

Education

• High school diploma or equivalent is required.
• Some college is preferred.