Insurance Verification Specialist

Job Description

Job Description

Description:

Overview of the role

The Insurance Verification Specialist (IVS) is responsible for verifying insurance coverage and obtaining necessary authorizations for patients requiring Continuous Glucose Monitoring (CGM) equipment. This role involves high-volume communication with insurance companies, patients, and healthcare providers to ensure seamless processing and approval of insurance claims.

Essential Duties and Responsibilities

Insurance Verification

o Verify patient insurance coverage and benefits for CGM equipment.

o Obtain pre-authorizations and pre-certifications as required by insurance providers.

Documentation

o Ensure all required documentation is complete and accurate for insurance claims submission.

o Maintain detailed records of insurance verification and authorization processes.

Communication

o Make 30+ outgoing calls per day to insurance companies, patients, and healthcare providers.

o Provide patients with updates regarding their insurance status and required documentation.

Administrative Duties

o Perform advanced administrative tasks including data entry and documentation follow-up.

o Supply regular productivity reports to management.

Collaboration

o Partner with team members to support related accounts and streamline verification processes.

o Work with e-prescribe and CRM platforms such as Brightree and Salesforce.

Other duties as assigned.

Requirements:

What'll You'll Bring

Ideal candidate has a basic knowledge of CGM equipment and DME (Durable Medical Equipment) sales processing. medical terminology, an energetic, optimistic demeanor, and a “can do/will do” attitude!

· Excellent verbal and written communication skills.

· Professional telephone etiquette and the ability to build relationships with patients and providers.

· Urgency, professionalism, and empathy in dealing with patients and busy medical professionals.

· Proficient in Microsoft Office and data entry.

· Experience with CRM platforms (Brightree, Salesforce) preferred.

· Attention to detail and accuracy in documentation.

· Ability to work independently with little supervision.

· High school diploma or medical vocational/technical school graduate equivalent.

· Previous experience in medical office settings or DME sales processing preferred.

· Experience in high-volume call activity and medical documentation chasing.

Why Quest Health Solutions, LLC

We recognize our people drive everything we accomplish, and as such, we are dedicated to investing in our employees by fostering a culture of continuous learning, growth, and excellence.

Our team works hard, and we recognize the importance of taking care of ourselves. We offer a comprehensive suite of benefit offerings to support the health, well-being, and financial health of our employees and their families. Our robust benefits package underscores our commitment to our people, our most important asset.

Quest Health Solutions seeks excellence through diversity in its staff. We prohibit discrimination based on race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, disability, veteran status, or marital status.

Benefits

· Medical, Dental, and Vision Insurance

· Life Insurance coverage

· Paid time off and Holiday Pay

· 401K with company match option

· Growth opportunities