Insurance Verification Specialist

GENERAL SUMMARY:

The Verification Specialist is responsible for participating in procedure scheduling activities by collecting patient demographic and insurance information, processing and entering that data into the practice EHR/EPM for work with insurers in obtaining prior authorizations.. The Verification Specialist verifies insurance for all patients and other prospective clients as well as confirming insurers' guidelines are met prior to scheduling appointments and procedures. The Verification Specialist also coordinates requests for application of payment assistance.

Job Duties:

• Obtain prior authorization and verification of eligibility from insurance carrier for office visits, procedures, and MRI’s.
• Investigate and interprets all incoming insurance information regarding patient benefits or processing changes and communicates these to appropriate personnel following department protocol.
• Verify Auto and WC insurance with the insurance carrier and verify legal representation with the attorney's firm.
• Obtain co-pay and deductible information and accurately records this information into the EHR and practice management system.
• After obtaining verification of benefits, inform patient of high deductibles and/or prepayment for upcoming surgery or procedure, to be collected prior to or on day of service
• Effectively utilize automated tools. (Web Denis, C Snap)
• Coordinates insurance referral process with patient following department needs
• Performs referral check and makes the appropriate notes in practice management system.
• Handles phone inquiries from patients, payors, medical office, and or testing facility regarding authorization, benefits, or verification.
• Other duties as necessary and/or assigned.

MINIMUM QUALIFICATIONS

• Required Certifications, Registration or Licensure:
• • None
• Minimum Knowledge and Education:
• • High School Diploma or GED
• Minimum Work Experience:
• • Minimum 2 years medical billing office experience or equivalent experience with medical payors

Specific Knowledge, Skills, Abilities:

• Extreme accuracy in data analysis and reproduction
• Good communication and interpersonal skills
• Keyboard skills
• Medical terminology
• Knowledge of third-party billing rules
• Experience working with third-party payors

Working Conditions:

• Works in a normal busy office environment.