Precertification Specialist

Insurance Verification Specialist

Revenue Cycle Management is looking for a full-time Insurance Verification Specialist to join our team. Remote opportunity after 90 day of in-person training. The Insurance Verification Specialist is responsible for verifying the patient's insurance coverage, ensuring surgery and procedures are covered by an individual's insurance plan. Creates cost estimates prior to the surgery date and communicates cost to patients. In addition to, entering and verifying accurate data and updating patient benefit information in the Electronic Medical Records (EMR).

Essential Functions:

• Assists front office with verification questions or concerns
• Resolves any coverage issues and update patient EMR
• Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient EMR
• Serves as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts
• Verifies patient insurance coverage and benefits through online portals, phone calls, and other resources
• Verifies insurance eligibility along with benefits and ensures all notifications and authorizations are completed by the surgery date
• Identifies patient accounts based on self-pay, PPO, HMO, personal injury, workmens compensation or other managed care organizations
• Collects relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders
• Communicates with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained
• Responds to inquiries regarding patient accounts with appropriate and accurate information in a professional manner
• Ensures accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information
• Creates financial arrangements, alongside management, when a patient is unable to complete payment
• Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
• Collaborates with billing and coding departments to ensure correct processing of claims
• Calculates co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
• Completes high-quality work while adhering to productivity standards
• Performs miscellaneous job-related duties as assigned

Knowledge, Skills, and Abilities:

• Demonstrates ability to use basic computer functions, technology and Microsoft office (excel, word)
• Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations
• Ability to work independently with little or no supervision as well as function within a team
• Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization
• Good communication skills (verbal / written) providing a great patient experience
• Ability to work effectively in a fact paced environment
• Strong knowledge of managed care, medical terminology, CPT Coding and ICD10
• Demonstrates use of appropriate modifiers, HIPAA regulations, and insurance verification procedures
• Knowledge of payor guidelines including reading, understanding and interpreting medical records and payor requirements etc.
• Ability to think critically, assess problems and provide problem resolutions
• Demonstrates attention to detail, accountability, people skills, problem solving and decision-making skills

Education and Experience:

• High School Diploma or GED
• One (1) year of hospital revenue cycle experience
• One (1) year of general customer service experience

Benefits:

• 3 Medical Plans
• 2 Dental Plans
• 2 Vision Plans
• Employee Assistance Program
• Short- and Long-Term Disability Insurance
• Accidental Death & Dismemberment Plan
• 401(k) with a 2-year vesting
• PTO + Holidays

Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.