Insurance Verification Specialist

The Insurance Verification Clerk is responsible for obtaining verification of all insurance benefits for patients prior to their scheduled surgery. This information must be maintained, prior to scheduled visit, to reflect the most up to date coverage. Performs limited data entry for new patient accounts and/or existing patient accounts. Works closely with insurance companies and clinical staff members as needed.

• Has knowledge and understanding of all insurance company policies related to precertification and authorizations
• Accurate verification of all insurance benefits, and entry of new or updated insurance information for all patient accounts
• Works directly with multiple insurance websites for benefit and authorization validation
• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions
• Responsible for timely and accurate verification of patient insurance and appropriate compliance with payer pre-certification and authorization requirements
• Responsible for contacting surgery scheduler and resolving any insurance coverage issue prior to patient coming in
• Responsible for noting all amounts due in patient accounts and noting any additional information needed regarding patient billing and specialty services
• Works closely with Patient Accounts Representatives to place accounts On Hold if all authorization information has not been received
• Required to perform certain Utilization Review clerical tasks:
• Review patient census and determine status of patient during overnight admission
• Fax clinical records to insurance company to authorize patient’s overnight admission
• Follow-up on the status of the authorization request to ensure number of days approved by patient’s insurance company
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records
• Effectively and immediately communicate with Nursing Staff when authorization is not approved. (Nursing Staff will need to conduct a Peer to Peer Review with patient’s insurance company for possible approval.)
• Work closely with prior authorization coordinators
• Uses available tools to ensure the appropriate level of benefit, pre-certification and authorization details are obtained
• Must be able to effectively and willingly communicate any billing, insurance and/or estimates of payments issues to patients and schedulers as needed
• Work closely with billing teams to discuss and capture up-to-date benefit coverage for surgery patients
• Support billing staff in resolving any issues related to reimbursement based on coverage determination
• Maintain a professional relationship with physician teams
• Ensures document retention and destruction, when appropriate, in compliance with established policies and/or other applicable guidelines
• Maintain patient and hospital confidentiality
• Attendance and Punctuality are vital to this role
• Perform all other related duties as required by Management

Preferred Skills and Education

• Bachelor’s degree preferred, but not required
• Minimum of 1-2 years’ experience in a clinical or hospital setting
• Prior Insurance Verification experience in a medical office preferred

qualifications

• Insurance verification experience preferred
• Requires excellent telephone etiquette, computer, customer service and organizational skills
• Ability to navigate numerous insurance portals to review benefit coverage details
• Ability to work in a fast-paced environment
• Self-motivated to work independently and collaboratively within a team environment
• Ability to maintain good working relationships
• Demonstrates accuracy and attention to detail
• Ability to work with deadlines
• Requires little supervision to accomplish tasks
• Demonstrates professionalism in appearance/dress code