Insurance Verification Specialist

TOA Middle•Brentwood, TN

2d•Remote

About The Position

The Insurance Verification Specialist is responsible for the timely verification of medical insurance benefits. Day-to-day activities may include all or some of the essential functions listed below depending upon individual experience / knowledge and the needs of the organization which are subject to change from time to time. Utilizes the Workflow Daily Appointment Report for your site as a primary source for insurance verification and determining insurance compatibility with TOA’s managed care plans. Adhere to best practices standards in performing day-to-day follow-up tasks. This includes following procedures outlined in the “VOI Training/Procedure Manual”. Place phone calls to patients, patient’s family/significant other, insurance companies, and facility personnel in an attempt to acquire information necessary to verify. Responsible to resolves any issues with coverage, referrals, precertification and escalate complicated issues to the immediate manager. Also must have a basic knowledge and understanding of what a referral and an authorization are. Enters and ensures information in the insurance fields is correct to its entirety. If incorrect, information in the system must be updated appropriately. This includes moving any VOB’S, authorizations and clinical referrals. If encounters were billed incorrectly to a now corrected insurance, you must email collections so claims can be rebilled if needed. Familiar with a variety of the facility concepts, practices, and procedures. Relies on experience and judgment to plan and accomplish goals.

Requirements

High school diploma required
Must have experience reading and understanding payer eligibility electronic returns
Ability to differentiate between insurance plans, copay, deductible, and coinsurance
Requires accuracy, attention to detail, ability to follow directions, and organization skills

Nice To Haves

2-4 years of experience in insurance verification preferred

Responsibilities

Verify medical insurance benefits in a timely manner.
Utilize the Workflow Daily Appointment Report for insurance verification and determining insurance compatibility with TOA’s managed care plans.
Adhere to best practices standards and follow procedures outlined in the “VOI Training/Procedure Manual”.
Place phone calls to patients, patient’s family/significant other, insurance companies, and facility personnel to acquire necessary information for verification.
Resolve issues with coverage, referrals, and precertification.
Escalate complicated issues to the immediate manager.
Enter and ensure accuracy of insurance information in the system.
Update insurance information in the system as needed, including moving VOB’S, authorizations, and clinical referrals.
Email collections if encounters were billed incorrectly to a corrected insurance so claims can be rebilled.