Insurance Verification Specialist (On-site)

Gonzaba Medical Group•San Antonio, TX

15d•Onsite

About The Position

The Insurance Verification Specialist ensures patient insurance coverage is accurately recorded in the practice management system. The role systematically reviews scheduled patients and patients with coverage discrepancies, communicates concerns such as inactive coverage, errors, alerts, or non-contracted plans to relevant Gonzaba Medical Group (GMG) team members, and reviews discrepancy reports to help maintain accurate coverage for all patients. The specialist serves as a subject matter expert on GMG contracted and non-contracted insurance plans, answers questions from team members, and communicates concerns to clinical leadership to streamline patient arrival and registration. The position works closely with managers or their designees regarding insurance issues and advises the manager of pending or potential problems. Work may take place in a clinical or office setting within a clinic environment. The role has no supervisory responsibilities.

Requirements

Minimum high school education or equivalent.
At least two years of general office or customer relations experience preferred, preferably in a medical group or large group practice.
Skilled in using computers and EMR systems.
Knowledge of word-processing, spreadsheet, internet, and database software.
Understanding of Medicare, HMOs, PPOs, and the differences among benefit packages.
Excellent written and verbal communication skills.
Strong attention to detail and exceptional organizational skills.
Ability to complete efficient and accurate data entry at a computer terminal.
Ability to develop and maintain supportive, productive, and effective relationships with internal and external partners.
Ability to maintain strict confidentiality.
Ability to work efficiently under pressure.

Nice To Haves

Fluency in Spanish and English is preferred.
General office or customer relations experience in a medical group or large group practice is preferred.

Responsibilities

Collect, verify, and enter demographic and insurance information into applicable systems for new and established patient accounts with scheduled appointments.
Collect, verify, and enter demographic and insurance information for patient accounts with coverage discrepancies, even when no appointment is scheduled.
Obtain insurance information needed for clinical services and procedures.
Prepare reports for clinical departments about appointments that may be problematic or contain errors before the appointment date.
Review portals, instant message feeds, and reports for patient insurance inquiries, and respond completely and promptly.
Verify patient eligibility and benefit package information by phone or through online resources.
Obtain and document patients’ financial responsibilities, including copayments and deductibles, and relevant coverage information such as PCP and contracted status.
Record appropriate notes in the system about actions taken, insurance verification, and authorizations.
Create or maintain lists of GMG-contracted insurance plans and distribute them to relevant departments.
Review reports to ensure all listed patients with appointments are reviewed before their appointment dates.
Work with managers or designated personnel on insurance issues and advise the manager of pending or potential issues.
Answer GMG team members’ questions about insurance coverage and communicate concerns to clinical leadership.
Perform other related duties as assigned.