Insurance Verification Specialist

Job Summary The Insurance Verification Specialist 1, under general supervision, provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. This directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts. Essential Functions Of The Role Perform financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed on time. Complete appropriate payor forms related to notification and authorization. Coordinate the submission of clinical documentation from physicians to payers for authorization needs. Calculate accurate patient financial responsibility. Communicate promptly with Utilization Review, collaborate effectively with the physician and facility staff, and ensure financial clearance of the patient's account before any service during the hospital stay. Interpret complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits. Document systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement. Key Success Factors 1 year of healthcare or customer service experience preferred. Consistently meet performance standards of production, accuracy, completeness, and quality. Understand and adhere to payer guidelines by plan and service type. Have good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette. Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, including life or death situations. Exhibit high empathy and communicate well with patients and families during traumatic events and demonstrate exceptional customer service skills. Manage multiple, changing priorities in an effective and organized manner. Excellent data entry, numeric, typing and computer navigation skills. Basic computer skills and Microsoft Office. Qualifications Education: H.S. Diploma/GED Equivalent Experience: Less than 1 Year of Experience Benefits Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based on position type and/or level. #J-18808-Ljbffr Baylor Scott & White Health