The Insurance Verification Specialist II is responsible for verifying health insurance benefits for all new patients or existing patients. This position will contact patient’s insurance company to verify coverage levels and works with patients to walk them through their benefits information. Notify patient and help arrange alternative payment methods when insurance coverage does not cover services.
Responsibilities
Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider.
Notify patient and help arrange alternative payment methods when insurance coverage does not cover services.
Responsible for entering data in an accurate manner in order to update patient benefit information correctly in EMR and verify that existing information is accurate.
Perform routine administrative and clerical tasks to keep the offices of physicians and other health practitioners running smoothly.
Consistently review eligibility responses in insurance verification system.
Verify insurance coverage in a timely matter.
Request payments from patients and guarantors where appropriate.
Complete insurance verification for more complex visit types (e.g. major surgery).
Act as a point of escalation and monitor supervisory or secondary work queues.
Qualifications
High school graduate or GED certificate is required.
A minimum of 2-years experience in a physician billing or third party payer environment.
Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
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.
Must successfully complete systems training requirements.
