Insurance Verification Specialist / Specialty Billing Representative

Mid Atlantic Retina•Bethlehem, PA

7d•Onsite

About The Position

This position is responsible for verifying all benefits as they pertain to specialty drug injections and all the co-pay assistance funds. They are also responsible for following up with accounts receivable for any necessary payer. The role requires verifying benefits for scheduled injection appointments, evaluating benefits for patient responsibility, and obtaining necessary pre-authorizations or pre-determinations for specialty drug treatments. The specialist will monitor schedules for changes, assist in general billing AR, and act as a customer service representative for patient billing inquiries. Maintaining up-to-date knowledge of insurance carriers and their policies is crucial. The position may require overtime and travel to other Mid Atlantic Retina locations.

Requirements

Medical billing experience preferred.
Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
Experience with CPT codes and ICD-10.
Microsoft Office Suite required.
Creative problem solving within defined acceptable parameters.
Superior listening skills, professional demeanor, and appropriate firmness.
Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues.
Ensure proper procedures, protocols and processes are complied with consistently.
Works effectively with patients, employees, and physicians.
Maintains high volume productivity level for essential functions.
Maintains confidentiality.

Responsibilities

Verifies all benefits for scheduled injection appointments.
Evaluates all benefits for patient responsibility and notates accurate collection amounts.
Obtains all necessary pre-authorizations or pre-determinations for each patient to have treatment with a specialty drug.
Monitors all assigned schedules for add-ons and changes.
Assists in general billing AR when needed including but not limited to claims follow up, calls to insurances and anything necessary to obtain payment for all specialty drugs.
Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in accounts along with system files, and initiates appropriate corrective methods.
Act as customer service representative in person or by telephone for any patient's questions about their account.
Maintain up to date billing knowledge of insurance carriers and their clinical policies.
Works overtime as needed.
Travels to other MAR locations as needed.
Performs other duties as assigned.