Insurance Verification Specialist

Baystate Health•Springfield, MA

About The Position

Under the direction of the Insurance Verification Supervisor and Manager, the Insurance Verification Representative reviews, verifies, and secures patient demographic and insurance information; obtains authorization information; initiates required certifications for sponsored admissions; and works related denials to minimize bad debt expenses and maximize reimbursement. The role verifies eligibility and benefits, secures authorizations and referrals, follows up with payers, documents account activity, and collaborates with internal teams and other parties to address coverage issues and recover payment. The position also participates in cross-training, meets productivity standards, maintains an account accuracy rate of at least 97%, and uses required computer programs proficiently. The listed compensation range is $19.29 to $25.87 per hour, with a midpoint of $22.16. Actual starting pay may vary based on relevant experience.

Requirements

Medical billing and/or authorization and referral experience.
Microsoft Office Suite skills.

Nice To Haves

Healthcare accounts receivable experience or equivalent.

Responsibilities

Secure accounts to obtain proper reimbursement.
Verify eligibility and obtain benefits for assigned accounts; complete notifications of admissions and births, changes of admission status, and authorizations or referrals while applying third-party requirements for claims submissions.
Obtain required certifications and authorizations, identify potential coverage gaps, and collaborate with referring providers, PBO, Patient Accounting, Managed Care, Case Management, Financial Counselors, patient employers, and others to minimize self-pay balances.
Follow up with payers to resolve coverage and benefit issues, and accurately and completely document account activity in necessary applications.
Collaborate with Case Management, Denials Management, and Patient Accounting to recover payment for assigned denials.
Maintain knowledge of changing payer guidelines for benefits, eligibility, and authorization information using web portals and carrier communications.
Independently resolve insurance authorization and assignment issues.
Participate in cross-training to support efficient, customer-friendly service and meet or exceed established quality and productivity standards.
Meet all productivity standards for the position.
Maintain an account accuracy average rate of at least 97%.
Demonstrate understanding and skilled use of necessary computer programs.