The Insurance Verification Specialist I specializes in verifying patient insurance coverage, to ensure that correct insurance information needed is secured in the practice management system. This position requires professionals to spend extensive time researching accounts to determine correct insurance coverage and heavy interaction with insurance companies and patients.
Responsible to resolve accounts with unverified insurance coverage.
Researches system notes to discover proper insurance coverage.
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 patient's insurance coverage and changes in the billing system.
Resolves any issues with coverage and escalates any complications to supervisor/manager.
Corrects identification and selection of appropriate registered insurance. Corrects errors in various work queues to ensure correct claim filing or refiling of denied claims.
Notifies the servicing provider’s office personnel in a timely manner if registration is lacking critical information needed to bill for services.
High school graduate or GED certificate is required.
A minimum of 6 months 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.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.