Job description
Responsibilities for insurance verification specialistJOB SUMMARY
The Insurance Verification Specialist, under general supervision, provides patients, physicians and internal hospital personnel with insurance benefit information. This position ensures timely verification of insurance benefits and financial clearance which has a direct impact to the organizations reimbursement from payers for patient accounts that are scheduled and unscheduled.
ESSENTIAL FUNCTIONS OF THE ROLE
Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.
Completes appropriate payor forms related to notification and authorization.
Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
Calculates accurate patient financial responsibility.
Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patients account prior to scheduled or unscheduled service during the patients hospital stay.
Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.
KEY SUCCESS FACTORS
3 years of healthcare insurance verification experience.
Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
Ability to understand and adhere to payer guidelines by plan and service type.
Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
Excellent data entry, numeric, typing and computer navigational skills.
Basic computer skills and Microsoft Office.
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