Insurance Verification Specialist

Overview

Summary
:
The Insurance verification specialist is responsible for obtaining insurance information for all scheduled patients. The Insurance verifier is also responsible for ensuring the most accurate and up-to-date insurance information is maintained. This position also coordinates with other departments within the practice to ensure accurate and most up-to-date insurance information is obtained.

• Re-verify insurance information currently in the system to determine active coverage.
• Verify insurance information for each scheduled patient by using the EPIC verification feature as well as insurance provider websites.
• Prioritize incoming insurance verification requests according to urgency (e.g., patient in the office at the front desk).
• Contact patients to discuss insurance changes and updates based on verification information obtained.
• Communicate self-pay policy and out-of-pocket expense to patients with no insurance, and insurance out of network.
• Remain 72 hours ahead in verification of scheduled appointments.
• Notify the infusion authorization team on infusion patients with any new/updated insurance, immediately after verification is completed.
• Check appointments daily to ensure verification is completed for all patients added to the schedule with the 72-hour window.
• Update accounts with the most accurate and up-to-date insurance information, including specialist copays.
• Address any and all issues and discrepancies relating to insurance coverage.
• Communicate professionally with staff and patients.
• Communicate with scheduling and front desk regarding insurance related issues related directly to this process.
• Communicate any Medicaid patients maxed out on yearly office visits to the responsible billing team member.
• Ensure accurate insurance data is entered on the account.
• Ensure the most updated primary and secondary coverage status is appearing on the account in registration. Update any account with missing primary and secondary coverage status.
• Respond to all insurance related questions and inquiries.
• Respond to all emails, staff messages and voicemails within a 24-hour time period.

• High School Diploma, or equivalent.
• Experience working with insurance provider portals and Availity is a plus.
• Working knowledge of medical billing systems, particularly Epic is a plus.
• Excellent organizational skills.
• Strong analytical skills.
• Customer service oriented.
• Detail-oriented.
• Effective team player.
• Productive, dependable, and ability to work independently.
• Excellent verbal and written skills.
• Strong time management skills.
• Works well in an environment with firm deadlines; results oriented.
• Perform multiple tasks effectively.

• Frequent sitting, grasping, and speaking.
• Occasional reaching, bending and stooping.
• Frequent use of computer, keyboard, copy/fax machine, and phone.
• Possible exposure to infectious specimens (blood or bodily fluids or airborne pathogens).
• May be required to wear Personal Protective Equipment (PPE).
• While performing the duties of this job, the noise level in the work environment is usually quiet to moderate.
• Fast paced environment with occasional high pressure real time insurance verification cases.
• Work hours subject to office needs to ensure coverage during all hours of operation.