Insurance Verifier

USPI•Annapolis, MD

About The Position

The Insurance Verifier works closely with the billing supervisor, performing all components of the Insurance Verification/Authorization process for existing and new patients, while also collaborating with staff. This role supports the vision and mission of Anne Arundel Gastroenterology Associates by providing excellent customer service. The position excludes performing any clinical tasks related to patients, including assessing or evaluating a patient's medical condition or providing clinical advice, medical care, or recommendations.

Requirements

Must have working experience with all payer types: commercial, governmental, Medicare, Medicaid, HMO, etc.
Ability to cross over into different payers.

Responsibilities

Conducts insurance verification and authorization validation on scheduled patients to ensure eligibility and that benefits are in order for accurate claim submission and payment.
Utilizes online eligibility verification system and/or contacts the Payer directly via telephone and/or accesses payer website.
Requests pre-authorization/pre-certification for scheduled procedures, urgent procedures, and imaging.
Accurately notates the account with actions taken for pre-authorization/pre-certification.
Receives and schedules incoming referral appointments as per policy.
Follows up on pending authorization requests in a timely manner.
Communicates with patients regarding their financial responsibility to ensure collection of out-of-pocket payments (i.e., copayments, deductibles, self-pay) for procedures, as per policy.
Answers non-medical questions and gives routine non-medical instructions.
Acts as the connection between internal and external customers to assist in the account billing resolution process and to escalate issues which adversely impact claim submission and payment, as directed by supervisor.
Performs independent research prior to seeking management assistance.
Follows department policies and procedures as required to meet payer and regulatory requirements, including procedures related to release of information, record retention, privacy, and confidentiality.
Meets and/or exceeds the daily production goal as defined by the Manager.
Assists the management team in providing training, assistance, and/or guidance to other staff members in issues of accounts resolution through billing, collection, and/or denial processing techniques.
Provides information to the Manager in identifying possible areas of concern that impact account billing or collections accurately and in a timely manner.