Job Description

Job Title: Insurance Verification Specialist

Department: Billing

Position Summary: Responsible for insurance verification, precertification and preauthorizations.

Duties and Responsibilities Include but are not limited to:

• Assists with the verification of insurance benefits, eligibility, co-pay and deductibles.
• Precertification/preauthorization of indicated studies.
• Ensures that all precertifications/preauthorizations are done in advance, before the patient is scheduled for the studies indicated.
• Submits required notes to the insurance carriers for authorization purposes.
• Ensures documents (authorization/data/numbers are entered into EHR system appropriately.
• Alerts the physicians for non covered services.
• Communicates with the physicians and nursing supervisor with non supportive documentation.
• Reviews account information and identify patient balances, flags account for the reception desk and collection department.
• Communicates with all carriers: Medicare, Medicaid, Commercial, PPO, Network benefits, etc.
• Seeks advice and guidance from certified coder with regards to coding guidelines and any questions.
• Performs related work as required.
• Attends meetings as required.
• Practice and adhere to HIPPA regulations.

Qualifications and Specifications:

• Education-High School Diploma some college preferred.
• Knowledge of basic office procedures.
• Knowledge of basic office equipment including copier, fax machine, and computer.
• Ability to speak clearly concisely.
• Skills in dealing with interpersonal issues and patient relations.
• Ability to handle multiple priorities at once with minimal supervision.
• Knowledge of medical terminology.
• Ability to maintain confidentiality of patient information.

All employees are expected to:

• Understand the mission and vision of the clinic.
• Operate within the concept of patient focused care.
• Evolve into an effective team member.
• Maintain good grooming and personal hygiene habits.
• Adhere to attendance policies.
• Conform to employee policies and office procedures.

This description is intended to provide only basic guidelines for meeting job requirements, responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

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