Insurance Verification Specialist - OB/GYN

Northeast OB/GYN•San Antonio, TX

About The Position

Through the use of the Mod Med schedule, secure insurance verification strives to stay 5 days ahead using the Mod Med insurance verification system or other payer portals as necessary. Prioritize verification for same day or next day patients added in as necessary. Verification includes patient eligibility, benefits and network status for all payers for the patient. Discrepancies with any plans will require communication with patient and/or requesting a copy of the insurance card to resolve issues prior to the appointment and mitigate patient care delays in the clinic. Field insurance related calls from patients and other department team members timely prior to appointments which may include insurance network status, benefits, Coordination of benefits, etc. Update the patient account with insurance verification information. Documentation would include benefits of all payers, expectation of estimated patient responsibility to include deductible, coinsurance or copay due at time of service. Explain out of network policy to include loss of maximizing benefits and expectation to sign Out of Network Policy form at time of service. Communication will be documented in the patient account for historical reference. Review the insurance plan(s) loaded in Mod Med. Ensure plans are active and accurate payer matches the cards scanned. Ensure the plans are in the appropriate order as primary, secondary, tertiary to ensure clean claims and promote timely reimbursement. Ensure review of insurance information to include other payers not given by patient and investigate. Identify changes in payer addresses, networks, names, etc. to promote timely updates to our Insurance List and Insurance Dictionary. Stay abreast of changes to the Insurance List and provide feedback to management if discrepancies or trends are noted to include providers being dropped from a network. Collaborate with the Billing team to identify changes in insurance that may affect prior claims. Aim to be proactive and have real time communication with the Billing team to achieve favorable reimbursement outcomes. Ensure timely response with internal and external customers through all means of communication. Ensure professional demeanor at all times and strive to be of assistance by being a bridge to other departments as needed. Mitigate a blind transfer to another department and ensure timely and effective communication with front desk to ensure alignment. Perform additional duties that may be assigned.

Responsibilities

Secure insurance verification 5 days ahead using Mod Med or payer portals.
Prioritize verification for same day or next day patients.
Verify patient eligibility, benefits, and network status for all payers.
Communicate discrepancies with patients and/or request insurance card copies.
Field insurance-related calls from patients and team members.
Update patient accounts with insurance verification information.
Document benefits, patient responsibility estimates, and out-of-network policies.
Review insurance plans in Mod Med for accuracy and order.
Investigate other payers not given by patient.
Identify changes in payer information and update Insurance List/Dictionary.
Provide feedback on Insurance List discrepancies to management.
Collaborate with the Billing team on insurance changes affecting claims.
Ensure timely response with internal and external customers.
Maintain professional demeanor and assist other departments.
Mitigate blind transfers and ensure effective communication with front desk.
Perform additional duties as assigned.