Insurance Verification Specialist

Statement of Purpose:  Overall responsibility for ensuring that patient health care benefits cover required procedures. This position contacts a patient’s insurance company to verify coverage levels and works with individuals to educate them on their benefits information. This position works with the Revenue Cycle Team to ensure that patient claims have accurate information. Ensures the duties are completed in a timely and proper manner. This position is in a primary care and behavioral health social service setting with specialized LGBTQ care and services.

Primary Tasks/Responsibilities:

• Insurance Verification Specialist is responsible for obtaining verification of patient payer benefits and eligibility for medical, behavioral health and psych services includes Private Insurance, Veteran’s Association, Medicare/Medicaid.
• Ongoing written and verbal communication with various departments regarding patient insurance coverage, benefits and limitations of plans and requirements of pre-authorization.
• Contacting patients to communicate network coverage and patient responsibility (coinsurance, copay, deductible, out of network with benefits cost.)
• Communicate and educate patients on payment options such as payment plans, Sliding Fee Discount Program, etc.
• Using various databases, including eClinical works, Availity, and various payer portals to verify patients’ insurance coverage for medical, psych and behavioral health services.
• Maintain a working knowledge of specific contracts between the agency and various payers.
• Identifying eligible and ineligible services in a patient’s benefit package.
• Meet and maintain required deadlines for verification as it relates to New and Established patients.
• Requesting preauthorization for service/coverage when necessary.
• Contacting patients and assisting with updating Coordination of Benefits (COB).
• Works to meet State and Federal Regulatory guidelines and complies with agency policies and procedures.
• Ensures the duties are completed in a timely and proper manner.
• Communicating directly with patients to discuss financial responsibility.
• Documenting accurately and thoroughly in the EMR.
• Answering questions patients may have about billing.
• Collecting patient balances either as part of verification or when working self-pay accounts assigned in the billing queue for outstanding balances.
• Additionally, this individual works to meet State and Federal Regulatory guidelines and complies with agency policies and procedures.

 Education/Professional:

• Minimum of 2 years of experience in insurance verification in the primary care and behavioral health setting, preferred.
• Experience working with insurance companies, have extensive knowledge of different types of coverage and policies.
• Experience working with multiple third-party payers including Medicaid, Medicare, Managed Care, HMO/PPOs.

 Knowledge, Skills and Abilities Required:

• Strong knowledge of and able to easily navigate Medicaid, Medicare, HMOs, and private payer systems.
• Ability to multi-task, detail oriented, organized ability to maintain accurate records, work quickly to process items in a timely manner.
• Work well with others.
• Computer literacy, intermediate typing skills, knowledge of office machines and Microsoft Office (Excel, PowerPoint, Word, etc.)
• Good Organizational and time management skills necessary.
• Excellent phone skills with an emphasis on customer service.
• Knowledge of EMR systems, preferably with eClinical Works.
• Microsoft suite and data systems proficiency, including Electronic Medical Records.
• Ability to effectively communicate both written and verbally.
• Ability to effectively utilize problem-solving and decision-making techniques.
• Ability to make effective judgments and decisions based on objective criteria.
• Ability to tactfully interact with diverse personalities.
• High comfort working in a busy environment with changing priorities.

Requirements:

• Must possess and maintain valid Florida driver’s license and proof of insurance
• Must have reliable and accessible auto vehicle.
• Must pass necessary fingerprinting, Level II background checks and employment eligibility verification through the U. S. Department of Homeland Security’s E-Verify system, https://e-verify.uscis.gov/emp.