Insurance Verification Specialist

Community First Health Centers is looking for an exceptional candidate for the Insurance Verification Specialist position located at our New haven Medical Facility. The Insurance Verification Specialist plays a crucial role in ensuring insurance eligibility for all patients before scheduled appointments, collaborating with third-party payers for both primary care and OB-GYN care patients. This position reports to the Practice Manager and is located at 58144 Gratiot Avenue, New Haven MI.

This is a full time opportunity, 40 hours per week. Hours of work are Monday-Friday, 8:30 am - 5:00 pm.

General Responsibilities

• Promote and maintain awareness of agency programs, services, and activities.
• Maintain professional and technical knowledge by attending educational workshops, online/in-person trainings, and/or participating in professional societies as needed/directed.
• Review and enter data and validate patient information.

• Researches and corrects invalid or incorrect patient demographic information such as invalid insurance policy numbers to ensure proper billing.
• Ensure all insurance information is entered accurately in EMR.
• Review patient insurance information and verify in advance the procedures/treatments that their policies will cover.
• Verify insurance using either and/or a combination of the organization's EMR, registration system, online verification platforms, or by contacting third-party payers directly to validate patient’s coverage.
• Send the proper documentation to verify authorizations to insurance companies for procedures which require them.
• Verifies participating status of providers.
• Determines member benefit coverage.
• Monitor and verify insurance information for individual patient visits and procedures.
• Contacts providers with authorization, denial, and appeals process information.
• Assists in educating and acts as a resource to front office staff.
• Works and assists with the billing department in correcting and resolving rejected, incorrectly paid, and denied claims as requested.
• Responds professionally to all inquiries from patients, staff, and payors in a timely manner.
• Accurately documents patient accounts of all actions taken.
• In accordance with HIPAA, this position must maintain the confidentiality of the patient in all circumstances as well as company confidentiality.
• Communicates with clinic staff to obtain necessary documentation if/as necessary.
• Responsible for researching and staying current on insurance changes and updates.
• Determine insurance financial information such as coinsurance, deductible, etc. used to determine patient responsibility.
• Coordinate with clinic staff if items are determined to be not covered.
• Ensure authorizations provided by insurance companies are accurate and contain correct codes, quantities, and appropriate authorization date ranges.
• Updates patient chart with necessary notations, authorization numbers, and documentation.
• Contact patient for updated insurance information.
• Perform other duties as assigned.

Community First Health Centers is a non-profit, Federal Qualified Community Health Center. We have been providing health care services through our nation’s health center program since 1975. We service Macomb and St. Clair counties with offices in Algonac, New Haven & Port Huron. While our focus will always be on the underserved, our doors are open to the entire community in which we practice. Our mission is to provide high quality, patient centered health care that is respectful, compassionate and accessible to all members of our community. Our care is customized to each patient and offered in a “patient first” atmosphere with exceptional customer service.

Why work for Community First Health Centers?

Community First Health Centers: Improving the quality of life for our community!!
Equal Opportunity Employer