Insurance Verification Specialist

InMindOut Emotional Wellness Center LLC • New Braunfels, TX

98d

About The Position

The Insurance Verification Specialist plays a vital role in access to healthcare services by ensuring accurate verification and validation of insurance coverage, obtaining pre-authorizations, and entering data accurately into the EHR, thereby facilitating seamless billing and reimbursement processes. The Insurance Verification Specialist must have expertise in medical insurance policies, and excellent communication skills to handle insurance coverage inquiries and interact with patients, insurance providers, and staff. His/her ability to thrive in a fast-paced environment will contribute to the overall efficiency and success of this position.

Requirements

• Must possess a high school diploma or General Educational Development (GED) certificate.
• Required: 6 months of healthcare or related experience.
• Preferred: Minimum of 1 - 3 years of experience in a medical office setting, a healthcare or related field.
• Preferred: Knowledge of business processes usually obtained from a degree in Business Administration, or Health Care Administration.
• Required: Valid state Driver’s License.
• Preferred: Automobile insurance with reliable transportation.

Nice To Haves

• Knowledge of maintaining information in an EHR.
• Knowledge of insurance guidelines including HMO, PPO, and other payer requirements and systems.
• Knowledge of medical terminology likely to be encountered in insurance verification and/or claims.
• Familiarity with CPT and ICD-10 Coding.
• Bilingual skills in English and Spanish language.

Responsibilities

• Verify and validate insurance coverage for patients prior to their appointments or procedures.
• Determine patients' insurance benefits, including deductibles, co-pays, and coverage limitations, to ensure accurate billing and reimbursement.
• Accurately record insurance details and related information into electronic health records (EHR) systems or practice management software.
• Communicate with patients and staff to obtain necessary insurance information, update records, and address any insurance-related concerns or questions.
• Communicate with insurance providers to obtain pre-authorization for medical services, ensuring compliance with their requirements.
• Collaborate with the billing department to resolve any insurance-related issues and discrepancies to ensure timely reimbursement.
• Assist in the preparation and submission of insurance claims, ensuring accurate coding and adherence to insurance guidelines.
• Stay up to date with insurance regulations and guidelines, ensuring compliance with IMO, legal and ethical standards.
• Handle insurance-related inquiries, resolve issues, and troubleshoot any discrepancies or denials, escalating complex cases when necessary.
• Collaborate with the staff and management to identify and address any potential issues and/or areas for improvement.
• Prioritize and manage insurance verification tasks to meet deadlines and maintain efficient operations within the medical office.
• Prepare and submit accurate documentation, data, and reports related to insurance verification activities and compliance.
• Other duties as assigned in support of the organization.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 11-50 employees