Insurance Verification Specialist

Verifications Specialist

The Verification Representative is responsible for verifying and obtaining eligibility and benefits as required by insurance companies dependent upon the plan coverage for all patients in the region. The Verification Representative reports to the Verification Supervisor. The Verification Representative is responsible for: entering all pertinent information gathered into the billing software for tracking purposes, maintaining contact with individual office locations within their region, coordinating with the regional Patient Service Representative (PSR) staff the information needed for all patients, preparing reports of daily activity as requested for management, scanning pertinent information into the patient chart for access from individual clinics in the region and the central billing office, working Daily Schedule Report twice daily but in advance if time allows, assisting with logistical and/or clerical problem resolution related to the patient's medical record, authorization and billing issues, and also responsible to follow standardized processes and work flow.

Job Requirements

Essential Job Functions

1. Answer calls from regional office locations, insurance companies and representatives of insurance companies using exemplary customer service skills.
2. Accurately enter and scan required information into computer database.
3. Follow standardized processes and work flow as required for job functions.
4. Review structured regional clinical data matching it against specified encounter(s) and follow established procedures for authorizing request and establishing benefits and eligibility for said encounter(s).
5. Enter obtained information with precertification numbers as needed.
6. Report data ran two-three times daily with emphasis on daily encounters scheduled, as well as new patient same day encounters. Report data then worked in advance with next days' schedule as priority.
7. Maintain patient confidentiality as defined by state, federal and company regulations.
8. Review errors and denials for regional assigned clinics. Properly communicating these issues back to the Verification Supervisor.
9. Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families and clinicians.
10. Have EHR Familiarity with note retrieval.
11. Actively support departmental and corporate strategic plans to ensure successful implementation.
12. Maintain cooperative working relationships with all clinic PSR staff and clinicians.
13. Research and correct invalid or incorrect patient demographic information such as invalid date of birth or insurance policy number to ensure proper billing and clean claims initiatives.
14. Responds professionally to all inquiries from patients, staff, and payors in a timely manner.
15. Keeps management informed of changes in authorization process, insurance policies, billing requirements, credentialing issues as they pertain to claim processing.
16. Accurately documents patient accounts of all actions taken.
17. Establishes and maintains a professional relationship with all staff in order to resolve problems and increase knowledge of account management.
18. Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
19. Informs management of any billing concerns, backlogs, insurance issues, problem accounts and time available for additional tasks.
20. As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
21. Completes additional projects and duties as assigned.
22. This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.

Specifications

Knowledge and Abilities

• Demonstrates overall knowledge of authorization, benefits and claims processing for insurance companies and plans both private and government.
• Demonstrates the ability to make decisions, assess and resolve problems effectively.
• Demonstrates the ability to carry out assignments independently, work form procedures, and exercise good judgement.
• Demonstrates the ability to maintain the confidentiality of all records
• Demonstrates ability to manage multiple tasks and demands given tight time constraints while ensuring high degree of accuracy and attention to detail.
• Effective interpersonal skills in a diverse population.
• Ability to use computer and phone for extended periods of time.
• Proven effectiveness in verbal and written communication
• Demonstrates overall knowledge of verification and authorization processing for insurance companies including private, commercial and government carriers.
• Demonstrates overall knowledge of managed care plans.
• Demonstrates overall knowledge of workers compensation rules and guidelines for claim authorization and payment.
• Must be able to communicate effectively and foster positive relationships.
• Word processing & spreadsheet application knowledge is preferred.
• Ability to work independently with minimal supervision as well as ability to work in a team environment.
• Skilled at managing multiple projects and grasping new concepts.
• Knowledge of healthcare industry with emphasis on benefits, eligibility and authorizations.
• Accurately complete assignments while meeting deadlines.
• Excellent organization skills.
• Excellent internal and external customer service skills.
• Must possess good oral and written communication skills and recognize importance of teamwork.

Experience

• High School Diploma or equivalent certification.
• One year experience working in healthcare system preferred.
• One Year eligibility, verification experience on an automated patient accounts system preferred.
• Understanding of clinic operations, related to patient registration, referrals, authorization & cash collections.
• Comprehensive working knowledge of third party insurance processes required.
• Intermediate to expert knowledge and computer skills including Windows programs and database applications preferred. Includes good keyboard skills 45+ wpm with high accuracy rate.
• Training or education in computer/database systems and practice management systems.
• Understanding of insurance payor reimbursement, authorization, collection practices, practice management systems follow-up helpful.
• Ability to prioritize tasks and delegate duties.
• Ability to communicate effectively in written and spoken English.

Within the bounds of their respective job descriptions, all staff is expected to exercise principle-centered leadership, focused on customer service responsiveness, with a continuous quality improvement orientation.