Insurance Verification Specialist

The Insurance Verification Specialist is responsible for (but not limited to) verification of all insurance to determine actual benefits of in-patient and outpatient procedural and admitted accounts requiring an extensive knowledge on medical insurance.  Notifies all insurance companies of outpatient and inpatient admissions for authorization, audits IP/OP procedural accounts, obtains prior authorizations for facility services that require such.  Provides excellent customer service to patient and staff alike.

KEY RESPONSIBILITIES 

Performed majority of the time:

·       Obtains needed insurance, health and financial information on patients coming into the hospital.

·       Updates patient accounts as needed.

·       Communicates to patient the patient’s financial responsibility as needed.

·       Obtains and verifies insurance within department standard and ensures proper insurance authorization is obtained.

·       Responds to voicemail within 24 hrs.

·       Maintains equipment and reports equipment failures promptly to facilitate repairs.

·       Refers accounts that do not have insurance to the Financial Counselor.

·       Addresses Case Management concerns and complaints.

·       Attends department meetings and provides insurance updates to the team.

·       Reviews active medical records for presence of diagnosis and orders.

Performed occasionally but critical to successful performance of the job:

·       Formulates and updates policies and procedures for insurance verification. 

Education:

Required

·       N/A

Preferred

·       Associate degree with college accounting courses or equivalent accounting experience.

Experience:

Required

·       Minimum one (1) year of hospital and insurance verification experience.

Preferred

·       N/A

Licenses, Certifications and/or Registrations:

Required

·       N/A

Preferred

·       N/A

Job Related Skills, Abilities and Behaviors:

Required

·       Computer experience.

·       Demonstrates proper, professional appearance and personal conduct for the employee’s particular job.

·       Insurance contracting knowledge preferred.

·       Must have the ability to organize and prioritize large volumes of work, while supporting the needs and work load of your immediate team members and management.

·       Experience working with highly confidential material/information.

·       Medical billing and insurance terminology required.

·       Medical terminology required.

·       Requires self-discipline and sense of responsibility, as job requires strict attention to detail.

·       Excellent customer service skills.

·       Must be effective in verbal and written communication.

·       Uses effective communication skills.

·       Ability to read and understand physician’s orders.

·       Utilizes electronic equipment and communication devices.

·       Effectively uses online data bases throughout the insurance verification process.

·       Assumes responsibility for maintaining competency in all areas where training was completed.

·       Demonstrates confidentiality regarding patient and co-worker information according to PHI level of access.

·       Prioritizes workload.

·       Looks for ways to improve customer service.

·       Formulates and uses effective working relationships with all healthcare team members, patients and significant others.

·       Fosters positive work environment through teamwork and assistance.

·       Demonstrates the ability to be self-disciplined, motivated and a self-starter.

Preferred

·       Bilingual skills a plus.