Insurance Verification Specialist

Insurance Verification Specialist

ESSENTIAL FUNCTIONS OF JOB : (other duties may be assigned)

1.Verify insurance information for new and existing clients

KEY MEASURES :
• Responsible for effective and efficient verification of all client benefits prior to their service date
• Review and analyze insurance information to ensure accuracy and completeness

• Update client records with insurance information and any changes in coverage
• Act as a liaison between clients, providers and insurance carriers to ensure all proper measures are taken and information is collected

2.Customer service contact for clients, families, providers, and insurances

KEY MEASURES:
• Responsible for answering incoming calls from other providers, clients, and carrier groups in relation to insurance coverage

• Ensures all client questions are answered and issues are resolved timely by utilizing the appropriate resources
• Assist clients with understanding their insurance benefits and coverage
• Explain to clients what their financial responsibilities will be
• Answer questions related to charges and insurance

3.Work with other Care Access staff on authorizations and tracking of current authorizations.Share information

regarding denials with appropriate program staff

KEY MEASURES :

• Share information regarding denials with appropriate program staff.
• Communicate with insurance companies to obtain necessary authorization information
• Inform relevant clinical staff and department administration about denials

• Collaborate with billing team to resolve any insurance related issues or denials

1. Perform Monthly Administrative Responsibilities

KEY MEASURES :
• Research eligibility information
• Assist with follow up for Coordination of Benefit issues
• Assist with reporting of department statistical information/KPIs

OTHER DUTIES OF JOB :

1.Attend meetings as required


2.Work with Billing department on follow up with various insurance companies and internal departments to insure balances are resolved in a timely manner

3.Remain current with payer billing guidelines and coding updates.

4.Cross train in order to cover other Care Access insurance verification staff

5.Perform other related duties as required.

SUPERVISION RECEIVED :

Supervision is received from the Director of Care Access, with input from the Revenue Cycle Manager.


SUPERVISION GIVEN :

None

WORKING CONDITIONS :

1.Managing multiple projects/tasks with numerous interruptions.


2.Close attention to detail.

3.Regular deadlines.


4.Predictable work schedule

5.Work closely with others.

6.Much record keeping/routine paperwork.

7.Requires creativity.

MENTAL/PHYSICAL REQUIREMENTS OF JOB :

The following is required on a regular basis:

Sitting, finger dexterity, talking, hearing, visual acuity operation of computer equipment, managing multiple projects/tasks, close attention to detail, predictable work schedule, frequent deadlines, closely supervised, work closely with others, and much record-keeping/routine paperwork.


The following is required on an occasional basis:

Lifting an average of ten pounds, standing, walking, and reaching.

WORK ENVIRONMENT:


Office environment.

QUALIFICATIONS :

A. Education/Training/License/Certification :

This position requires an Associate's degree (A.A.) or equivalent from a two-year college or technical school; or at least one year related experience and/or training; or equivalent combination of education and experience.Education, training, and/or experience should include knowledge of verification, authorization, and billing requirements for Medical Assistance, Commercial, and Managed Care insurers, general billing processes and procedures, and electronic billing systems.


CONDITIONS OF EMPLOYMENT:

Daytime work schedule, 5 days/week. Occasional flexibility required.

Obtain and maintain required clearances.

Complete required agency training.


KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED :

1.Understanding of healthcare billing and insurance procedures, documentation, and standards in a managed care environment.

2.Understanding of operational characteristics and procedural requirements of third-party medical insurance payers;


3.Understanding of insurance authorization requirements;


4.Ability to read and comprehend simple instructions, short correspondence, and memos, as well as the ability to write correspondence.

5.The ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

6.Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals, as well as the ability to compute rate, ratio, and percent, and to draw and interpret bar graphs.

7.Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form, as well as the ability to deal with problems involving several concrete variables in standardized situations is required.


8.Knowledge of office equipment operation.

9.Excellent documentation skills.


10.Excellent communication skills, both verbally and in writing.