Medical Insurance Verification Specialist

Medical Insurance Verification Specialist

Location: Daytona Beach

The Medical Insurance Verification Specialist works to ensure that patients' health care benefits cover required visits and procedures performed at the clinic.

The specialist contacts a patient's insurance company to verify coverage levels and works with patients to educate them on their benefits information and helping them to financially get the medical procedures they need.

Physical Qualifications

Requires prolonged sitting, bending, stooping and stretching, hand-eye coordination and manual dexterity to operate keyboard, photocopies, telephone, and other office equipment. Requires normal range of eye sight, hearing and aptitude to record, prepare, and communicate appropriate information and documenting in the clinic patient software. Must physically be able to spend much time on the phone and/or utilizing insurance website.

Job Qualifications

1. High School Diploma 2. Previous experience in a medical group practice environment preferred. 3. Medical Insurance verification experience and knowledge of Medicare, Medicaid and third party insurance payers preferred.

Certificate/License

Certified Patient Service Specialist (CPSS), obtained within 6 months of hire date.

Performance Expectations

• Accurately carries out the responsibility for verifying patient insurance coverage, and ensures that necessary visits and procedures are covered by an individual's provider.
• Responsible for entering data in an accurate manner, updating patient benefit information in the clinic's insurance system and verifying that existing information is accurate.
• Demonstrates proficiency in working with insurance companies, and has extensive knowledge of different types of coverage and policies.
• Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented and organized, and maintains accurate patient insurance records.
• Possesses the ability to focus and work quickly. Patient insurance paperwork is processed in a timely manner.
• Serves as a trusted resource to patients, providing them with pertinent information regarding their coverage. Clearly explains to patients the coverage amounts provided by their insurance policy, so they can understand why some procedures may be covered, while others are not.
• Is proficient in the use of Availity and insurance-specific portals to accurately verify insurance coverage and patient responsibility.
• Uses judgement in forwarding patients to a Patient Accounts Specialist for arrangements payment plans for services that are not covered by insurance and there is a need to discuss different financing options to fit their budgets.
• Utilizes problem-solving skills in verifying inaccurate information recorded in the clinic financial system. Knows when it is appropriate to use Availity, the insurance portal, or call the patient.
• Uses good judgement in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient's insurance premium was not paid).
• Consistently forwards patients who have outstanding balances to a Patient Accounts Specialist.
• Provides immediate verification of benefits as needed for same or next day added-on patient appointments.
• Provides completed patient verification list to the Medical Records Authorization Clerk 3 days in advance, so that authorizations and chart prep may be completed in a timely manner.
• Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.
• Maintains and adheres to the company's OSHA, HIPAA, and Compliance regulations.
• Other duties as assigned.

This is not a remote position.

Company provides a comprehensive benefits package including Medical, Dental, Vision, Life, Long-Term Disability and Supplemental policies, Paid Time Off, 401k plan with company matching and uniform allowance.

Job Type: Full-time

Florida Retina Institute