Insurance Verification Specialist

South Heart Clinic•Brownsville, TX

4d•Onsite

About The Position

Responsible for insurance verification, precertification and preauthorizations. This role involves assisting with the verification of insurance benefits, eligibility, co-pay and deductibles, as well as performing precertification/preauthorization of indicated studies. The specialist ensures these authorizations are completed in advance of patient appointments, submits required notes to insurance carriers, and accurately enters authorization data into the EHR system. They also communicate with physicians and nursing supervisors regarding non-supportive documentation, review account information to identify patient balances, and interact with various insurance carriers including Medicare, Medicaid, Commercial, and PPO plans. Additionally, the role requires seeking guidance from certified coders on coding guidelines, greeting patients, checking them in, verifying information in the EMR, and entering patient information into the medical billing system. Maintaining appointment schedules, communicating with patients and providers, scheduling/rescheduling appointments, reminding patients of appointments, answering telephones, forwarding calls, collecting co-pays, and maintaining a neat work area are also key responsibilities. Adherence to HIPAA regulations is mandatory.

Requirements

High School Diploma
Knowledge of basic office procedures.
Knowledge of basic office equipment including copier, fax machine, and computer.
Ability to speak clearly concisely.
Skills in dealing with interpersonal issues and patient relations.
Ability to handle multiple priorities at once with minimal supervision.
Knowledge of medical terminology.
Ability to maintain confidentiality of patient information.
Understand the mission and vision of the clinic.
Operate within the concept of patient focused care.
Evolve into an effective team member.
Maintain good grooming and personal hygiene habits.
Adhere to attendance policies.
Conform to employee policies and office procedures.

Nice To Haves

some college preferred

Responsibilities

Assists with the verification of insurance benefits, eligibility, co-pay and deductibles.
Precertification/preauthorization of indicated studies.
Ensures that all precertifications/preauthorizations are done in advance, before the patient is scheduled for the studies indicated.
Submits required notes to the insurance carriers for authorization purposes.
Ensures documents (authorization/data/numbers are entered into EHR system appropriately.
Communicates with the physicians and nursing supervisor with non supportive documentation.
Reviews account information and identify patient balances, flags account for the reception desk and collection department.
Communicates with all carriers: Medicare, Medicaid, Commercial, PPO, Network benefits, etc.
Seeks advice and guidance from certified coder with regards to coding guidelines and any questions.
Greets patients and visitors in a prompt, courteous, and helpful manner.
Checks in patients, verifies and updates necessary information in the patients EMR.
Enters all of patient information into the medical billing system.
Maintains appointment schedule and follows office scheduling policies.
Communicates with patient and providers.
Scheduling, canceling, and rescheduling patient appointments.
Reminding patients of upcoming appointments and tracking missed appointments.
Answering multiple telephones and accurately documenting messages.
Forwarding telephone calls appropriately and following up on return calls.
Checking-in patients and properly documenting registration.
Collecting co-pays and cash from patients, getting authorization on credit cards.
Maintains work area and lobby in neat and orderly manner.
Practice and adhere to HIPPA regulations.