Insurance Verification Specialist II

Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual's provider. Notify patient and help arrange alternative payment methods when insurance coverage does not cover services. Responsible for entering data in an accurate manner in order to update patient benefit information correctly in EMR and verify that existing information is accurate. Perform routine administrative and clerical tasks. Verify insurance coverage in a timely matter. Request payments from patients and guarantors where appropriate. Perform related duties as assigned. Complete insurance verification for more complex visit types (e.g. major surgery). Act as a point of escalation and monitor supervisory or secondary work queues. Work with complex insurance companies for verifications. Requirements High school graduate or GED certificate is required. A minimum of 1-year experience in a physician billing or third party payer environment. Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations. Candidate must demonstrate the ability to understand and navigate the payer adjudication process. Patient financial and practice management system experience in Epic and other electronic billing systems is preferred. Knowledge of medical terminology is preferred. Previous experience in an academic healthcare setting is preferred. Core Competencies Demonstrates expertise in verifying patient insurance coverage and navigating the payer adjudication process, with proficiency in electronic billing systems such as Epic. Strong understanding of medical terminology and compliance regulations in a healthcare setting is essential. #J-18808-Ljbffr