Clinical Services Specialist

Job Description

Job Description

Overview

The Clinic Services Specialist’s overall responsibility is ensuring that patient benefits cover required services. Will verify insurance coverage and benefits for new and existing patients. Duties will include accurately verifying insurance benefits and eligibility using multiple resources, online portals and via phone. Requesting referrals and authorizations based on insurance guidelines. Determine patient responsibility and
updating information accordingly.

Responsibilities

• Prioritizing and following the established verification process

• Verify detailed insurance benefits, authorization and referral guidelines.

• Review and correct data entry errors made by scheduling team
• Accurately verify full insurance benefits and eligibility using online resources and phone
• Enter insurance referrals and authorizations as needed
• Notating what patient financial responsibility will be, such as copay, balances, and credits.
• Acting as a resource to staff and patients regarding benefits and eligibility
• Ensures all key information needed for the visit are in the patient’s chart, such as, labs/images,
chart notes, referrals and authorizations
• Ensures referring provider data is accurately entered in electronic system
• Support multiple AVP offices with Chart Prep services
• Responds to emails regarding verifications
• Engages patients in a courteous and helpful manner
• Applies knowledge of medical terminology to document appropriately
• Performs any and all duties as reasonably assigned
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations

Qualifications

• Knowledge of medical terminology and insurance is a plus.
• Must be computer literate.
• Ability to read, write, speak and comprehend written policies and documents.
• Must have consistent, predictable and reliable attendance.
• Commitment to AVP Core Values- Financial Strength, Exceptional Experience, Team Work, Continuous Improvement and Hard Work.
• Ability to work independently and communicate effectively.
• Desire to uphold and adhere to COVID 19 policies and procedures.
• Dedication to high quality patient care and patient satisfaction.
• Positive attitude and excellent telephone etiquette