Insurance Verification Specialist
Ensures that revenue cycle activities are completed daily including verification and authorization of healthcare services to prevent claims denials, appointment cancellation/rescheduling.
* Perform on-going communication to employees, patients and others as necessary to resolve insurance-related departmental issues.
* Acts as liaison between clinical staff, patients, referring physician s office and insurance. Payers by informing patients of procedures authorization delays/denials, answering questions, offering assistance, relaying messages, pertaining to the authorization of procedure/service
* May reschedule procedures (Manager Approval) in consideration of appointments cancelled due to insurance authorization issues and utilizing cancellation wait list to optimize departmental efficiencies.
* Monitors insurance authorization issues to identify trends and participates in process improvement initiatives. This may include running weekly volume, denial and scheduling reports.
* May perform revenue cycle activities required for registration, facilitating insurance pre-certification and authorization.
* Performs Yearly updates on payers to distinguish new plans and guidelines
* Must have basic knowledge of the different carriers, in and out of network benefits, copays, deductibles, and coinsurance.
* Maintain confidentiality and adhere to HIPAA guidelines/regulations.
* May have additional departmental specific duties as necessary.
Participate and assist with quality management reporting and projects.
Attend training sessions as specified by department leadership.
Clerical duties, including, but not limited to filing, typing, forms rotations, copying, answering calls and voicemail and other duties as assigned.
EDUCATION AND QUALIFICATION:
High School Diploma or equivalent, and completion of Medical Insurance Billing and coding Course.
* Three (3) years Healthcare experience required preferably in a medical office setting, handling insurance verification. GYN experience a plus.
* Minimum two (2) years experience with computerized billing system.
* Demonstrated working knowledge of Medical Terminology, ICD 10 and CPT codes
* Demonstrated multi-task and problem solving skills
* Knowledge of insurance plans, including Medicaid
* Strong organizational skills and analytical skills.
* Accurate and detail oriented.
* Demonstrated arithmetic and word mathematical problem solving skills
* Ability to work independently in a changing environment and handle stressful situations
* Must be able to speak and write in a clear and concise manner in order to convey messages and ensure that the staff understands, whether clinical or non-clinical
* Proficiency in Excel and Outlook.