Insurance Verification Specialist (Clinic)

Premier Medical Resources•Houston, TX

4d•Hybrid

About The Position

Premier Medical Resources is seeking a full-time Insurance Verification Specialist to join their team. This role is primarily responsible for verifying patient insurance coverage to ensure that surgeries and procedures are covered. The specialist will also create cost estimates, communicate these costs to patients, and maintain accurate patient benefit information in the Electronic Medical Records (EMR) system. The position offers remote work after an initial in-person training period of 30-90 days.

Requirements

Demonstrates ability to use basic computer functions, technology and Microsoft office (excel, word)
Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations
Ability to work independently with little or no supervision as well as function within a team
Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization
Good communication skills (verbal / written) providing a great patient experience
Ability to work effectively in a fact paced environment
Strong knowledge of managed care, medical terminology, CPT Coding and ICD10
Demonstrates use of appropriate modifiers, HIPAA regulations, and insurance verification procedures
Knowledge of payor guidelines including reading, understanding and interpreting medical records and payor requirements etc.
Ability to think critically, assess problems and provide problem resolutions
Demonstrates attention to detail, accountability, people skills, problem solving and decision-making skills
High School Diploma or GED
One (1) year of hospital revenue cycle experience
One (1) year of general customer service experience

Responsibilities

Assists front office with verification questions or concerns
Resolves any coverage issues and update patient EMR
Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient EMR
Serves as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts
Verifies patient insurance coverage and benefits through online portals, phone calls, and other resources
Verifies insurance eligibility along with benefits and ensures all notifications and authorizations are completed by the surgery date
Identifies patient accounts based on self-pay, PPO, HMO, personal injury, workmen’s compensation or other managed care organizations
Collects relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders
Communicates with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained
Responds to inquiries regarding patient accounts with appropriate and accurate information in a professional manner
Ensures accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information
Creates financial arrangements, alongside management, when a patient is unable to complete payment
Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
Collaborates with billing and coding departments to ensure correct processing of claims
Calculates co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
Completes high-quality work while adhering to productivity standards
Performs miscellaneous job-related duties as assigned