Insurance Verification Specialist / Specialty Billing Representative

Insurance Verification Specialist / Specialty Billing Representative

Specialty Billing is responsible for verifying all benefits as they pertain to specialty drug injections and all the co-pay assistance funds. They are also responsible for following up with accounts receivable for any necessary payer.

Essential Functions

1. Verifies all benefits for scheduled injection appointments.
2. Evaluates all benefits for patient responsibility and notates accurate collection amounts.
3. Obtains all necessary pre-authorizations or pre-determinations for each patient to have treatment with a specialty drug.
4. Monitors all assigned schedules for add-ons and changes.
5. Assists in general billing AR when needed including but not limited to claims follow up, calls to insurances and anything necessary to obtain payment for all specialty drugs.
6. Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in accounts along with system files, and initiates appropriate corrective methods.
7. Act as customer service representative in person or by telephone for any patient's questions about their account.
8. Maintain up to date billing knowledge of insurance carriers and their clinical policies.
9. Works overtime as needed.
10. Travels to other MAR locations as needed.
11. Performs other duties as assigned.

Competencies

1. Problem Solving / Analysis - Creative problem solving within defined acceptable parameters. Identifies and resolves problems in a timely fashion.
2. Customer Service- Superior listening skills, professional demeanor, and appropriate firmness.
3. Conflict Resolution- Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues.
4. Detail Oriented - Ensure proper procedures, protocols and processes are complied with consistently.
5. Strong Interpersonal Skills- Works effectively with patients, employees, and physicians.
6. Creative problem solving within defined acceptable parameters.
7. Time Management- maintains high volume productivity level for essential functions.
8. Ethical Conduct - Maintains confidentiality.

Required Education and Experience

1. Medical billing experience preferred.
2. Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
3. Experience with CPT codes and ICD-10. Microsoft Office Suite required.