Insurance Verification Specialist-Full Time

The Insurance Verification Specialist supports the Patient Access Department by accurately verifying insurance information, reviewing patient accounts for prior authorization needs, obtaining needed prior authorizations, and properly documenting all steps in the process. This position will also serve as a point of contact for clients and coworkers to ensure we process our insurance verification and authorization efforts to best care for our patients. This position may assist with training and mentoring other staff members as well as being available in the same capacity for our clients as needed. This position plays a key role in providing a smooth experience for patients and ensuring the organization receives appropriate reimbursement.

Principal Duties And Responsibilities

• Assists in training new insurance verification staff in accordance with organization’s standards
• Follows prior authorization work flow, policies and procedures
• Efficient time management skills and ability to multitask
• ICD-10, CPT, HCPCS codes, and coding processes
• Utilizes online systems, phone communication, and other resources to determine insurance eligibility and prior authorization needs for a scheduled patient event.
• Superb teamwork and conflict resolution skills
• Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, medical necessity, and registration.
• Strong understanding and comfort level with computer systems
• Exhibits professionalism in appearance, speech, and conduct; ensures that services are provided in accordance with organizational standards and policies
• Medical terminology
• Customer service experience preferred
• Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
• Manage correspondence with insurance companies, physicians, specialists and patients as required
• Coordinates benefits by effectively determining primary and secondary liability when needed
• Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements
• Performs other clerical duties as assigned by Patient Access Director and/or manager
• Proficient knowledge of the following:
• Excellent writing, oral, and interpersonal communication skills
• Verifies benefits, extent of coverage, pre-certification and pre-authorization requirements. Plus other limitations within a timeframe before scheduled appointments determined by Jennie Stuart Health.
• Various payer regulations and contracts
• Complies with all state and federal laws and regulations related to patient privacy and confidentiality, such as HIPAA
• Effectively communicating with patients, physicians, clinicians, front-end staff, and translators
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
• Alerts physician offices and patients to issues with verifying insurance or meeting pre-authorization requirements
• EHR programs (e.g., Sunrise, AllScripts and Athena, etc;)
• Experience as an Insurance Verification and Referrals within the organization, or at least two to three years of insurance verification or healthcare administration experience outside the organization required
• Ability to motivate and mentor others

Required Skills

• Ability to motivate and mentor others
• Superb teamwork and conflict resolution skills
• Excellent writing, oral, and interpersonal communication skills
• ICD-10, CPT, HCPCS codes, and coding processes
• Proficient knowledge of the following EHR programs (e.g., Sunrise, AllScripts, Athena, etc; )
• Medical terminology
• Efficient time management skills and ability to multitask
• Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, insurance authorization, medical necessity, and registration.
• Strong understanding and comfort level with computer systems
• Various payer regulations and contracts
• Customer service experience preferred
• Experience with insurance verification and referrals within the organization, or at least two to three years of insurance verification or healthcare administration experience outside the organization required

Education

Required Experience

• Certified Healthcare Access Associate (CHAA) certification preferred
• Associate or bachelor’s degree in healthcare administration or related field preferred
• High school diploma or GED required