INSURANCE VERIFICATION REPRESENTATIVE

Insurance Verification Representative

The Insurance Verification Representative (IVR) is responsible for assisting all Client Service Specialists in processing insurance eligibility for all Care Resource patients, including Medical, Behavioral Health and Dental prior to scheduling appointments. Furthermore, the IVR conducts a thorough verification of all appointments on the providers' schedule two days prior to the Date of Service (DOS). The IVR informs patients of any financial obligations, prior authorization, and/or required referrals, before the visit. He/she responds to all internal and external phone calls regarding insurance verification inquiries, including commercial, governmental, and Ryan White.

Patient/Client Services:

• Verifies all Commercial insurances, Medicare, Medicaid, and Ryan White for eligibility and benefits for future scheduled appointments, as well as, same day and walk-ins whenever applicable and based on need.
• The representative will create an account on all insurances portals to retrieve updated information about the patient.
• If the client detains a commercial plan, it is the clerk's responsibility to verify if a Medicaid/Medicare coverage is active by exploring their website.
• The clerk ensures to follow the different steps of Care Resource Insurance Verification process.
• Resolves routine general questions and/or issues/concerns presented by patients and customers via phone and related to insurance eligibility and referrals requirements.
• Works closely with direct client contact services departments, as well as, with other team members in the Client Engagement Services Department, to assist in identifying patient financial responsibility.
• Provides accurate information by identifying and alerting appropriate front desk support staff about patients' financial responsibility, to effectively collect owed money at the time of check in, including past due balances.
• Accounts and properly documents all customer/payer interactions, including records details, complaints, comments, and actions taken.
• Helps with special projects as needed.
• Complies with HIPAA rules and regulations when communicating with patients, clients, health center personnel, and external vendors and payers.

Safety:

• Ensures proper hand washing according to Centers for Disease Control and Prevention guidelines.
• Understands and appropriately acts upon assigned role in Emergency Code System.
• Understands and performs assigned role in health center's Continuity of Operations Plan (COOP).

Culture of Service: 3 C's:

• Compassion: Greets internal or external customer (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.
• Listens to internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring an understanding of the request and providing appropriate options or resolutions.
• Competence: Provides services required by following established protocols and when needed, procures additional help to answer questions to ensure appropriate services are delivered.
• Commitment: Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed.

Other duties:

• Participates in training sessions and other meetings as required by the health center and/or funding sources.
• Participates in health center developmental activities as requested.

Job Specifications:

• Education: High School diploma or General Education Degree (GED) is required. College education in related field is preferred.
• Training and Experience: Two years of work experience processing insurance verification for Medicare, Medicaid, and Commercial Insurance payers is required. Medical Billing/Coding Certification and knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-10) knowledge is a plus.
• Job Knowledge and Skills: Bilingual (English Spanish/ English-Creole) is required. Computer knowledge should include Microsoft Word, Excel and Outlook. Knowledge of Electronic Health Records (i.e., NextGen), Availity is highly recommended. Proven excellent customer service skills, phone etiquette, and outstanding communication skills are required. Good organizational and teamwork skills are required. Ability to work with multicultural and diverse population is required.
• Contact Responsibility: The responsibility for internal and external contacts is frequent and important.
• Other: Own transportation is required.

Physical Requirements:

• This work requires the following physical activities: frequent sitting, bending, and standing, walking, talking in person and talking on the phone. Occasional driving, stretching/reaching and lifting to 50 lbs. are required. Work is performed in an office setting.