Insurance Change Specialist

VieMed Healthcare • Lafayette, LA

2d

About The Position

The Insurance Change Specialist obtains patient demographic and health insurance information, collects co-pays when appropriate, verifies and records insurance benefits, and provides insurance breakdowns. The specialist obtains prior authorizations when required by payers and follows up on authorizations daily as needed. The role also involves reviewing medical documentation, resolving Front Collections accounts, and documenting work in the computer system.

The specialist establishes and maintains effective working relationships with patients and families, physicians’ offices, and internal teams. Additional clerical duties include answering patient and insurance calls, sending faxes and emails, and communicating concerns or issues to the Revenue Cycle Manager and Supervisor. Other responsibilities and projects may be assigned.

Requirements

• High school diploma or equivalent.
• Learn and maintain knowledge of the current patient database and billing system.
• Verify insurance for all products.
• Understand insurance benefit breakdowns, including deductibles and co-insurance.
• Understand insurance medical and payment policies.
• Know how to interpret Explanation of Benefits from insurance companies.
• General knowledge of government and regulatory billing and compliance regulations and policies for Medicare and Medicaid.
• Working knowledge of CPT and ICD-10 codes, HCFA 1500 and UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, and insurance benefits.
• Sufficient knowledge of policies and procedures to accurately answer internal and external customers’ questions.
• Use initiative while maintaining established productivity levels and consistent accuracy.
• At least 1 year of insurance verification or authorization experience.
• Superior organizational skills.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective and professional written and oral communication skills.

Nice To Haves

• 2–4 years of experience in DME or a medical office is preferred.

Responsibilities

• Obtain patient demographic and health insurance information and collect co-pays when appropriate.
• Verify and record insurance benefits and provide insurance breakdowns.
• Obtain prior authorizations when required by payers and follow up on authorizations daily as needed.
• Read and understand medical documentation.
• Resolve Front Collections accounts and document appropriately in the computer system.
• Maintain effective communication and working relationships with patients and families, physicians’ offices, and internal teams.
• Perform clerical tasks such as answering patient and insurance calls, faxing, and emailing.
• Communicate appropriately with the Manager/Supervisor and other superiors; report concerns or issues directly to the Revenue Cycle Manager and Supervisor.
• Complete other responsibilities and projects as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED