The Insurance Verification Specialist III specializes in verifying patient insurance coverage, to ensure that correct insurance information needed is secured in the practice management system. The Lead Insurance Verification Representative is also responsible for assisting management with the daily work assignment, staff training, and quality audits.
Responsible to resolve accounts with unverified insurance coverage.
Researches system notes to discover proper insurance coverage.
Contacts patient as appropriate to obtain proper insurance coverage
Contacts insurance company(s) as appropriate.
Verifies insurance via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone), obtain benefit coverage.
Confirms effective and termination dates of patient insurance and updates insurance coverage and changes in billing system.
Resolves any issues with coverage and escalates any complications to supervisor/manager.
Secure payor required referrals.
Responsible for the correct identification and selection of appropriate registered insurance.
Assists Specialists I and II with problematic cases pertaining to the clearance of payor referrals, authorization or insurance eligibility issues.
Assists with new-hire training and staff refresher training materials.
Assists supervisor/manager with distribution of daily work assignments. Assists supervisor/manager with monitoring staff compliance with all office/unit policies, including but not limited to: daily attendance, dress code policies, personal phone/computer usage.
Assists management team with performing periodic quality audits.
High school graduate or GED certificate is required.
A minimum of 2 years’ experience in a physician billing or third party payor environment.
Candidate must demonstrate the ability to understand and navigate the insurance verification process including coordination of benefits, including in depth understanding of In/Out of Network Benefits and how they relate to co-insurance and deductibles due.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Intermediate proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently and be a team player.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.