Regional Insurance Verification Specialist

Surgery Partners, Inc•, UT

2d•Remote

About The Position

This role is responsible for ensuring all records are maintained with absolute integrity and in compliance with applicable regulations and requirements. The specialist will obtain or update required referrals and authorizations via phone, fax, or online. They will review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification. This position involves data entry in a fast-paced environment with high expectations on accuracy, updating patient accounts with insurance verification details, and coordinating with patients regarding their insurance benefits. The specialist will identify deductibles, co-pays, and self-pay accounts, and notify appropriate staff if treatment or service is denied. Additionally, they will assist the manager and other staff with account questions and perform other duties as assigned, relying on experience and judgment to plan and accomplish goals.

Requirements

Knowledge of revenue cycle in healthcare
Knowledge of clinic policies and procedures.
Knowledge of managed care contracts and utilization.
Knowledge of computer systems, programs, and spreadsheet applications.
Knowledge of medical terminology.
Knowledge of CPTS/ICD-9
Skill in gathering and reporting claim information.
Skill in solving utilization problems.
Skill in written and verbal communication and customer relations.
Ability to work effectively with billing and medical staff and external agencies.
Ability to identify, analyze and solve problems.
Ability to practice time management
Ability to prioritize and stay organized
Requires sitting and standing associated with a normal office environment.
Employee must ensure they have an environment appropriate for work purposes that includes telephone and computer work.
Employee must have appropriate telephone and secure internet connections suitable to meet role requirements.
Employee must have quiet, private space to maintain confidentiality.
The location must allow the employee to devote his/her attention to work during expected work hours.
Employee must be able to carry out same duties, assignments, and work obligations at their home office as they would when working on premises.
Workweek remains the same as the scheduled working hours for the CBO
Employee must receive prior approval for any time away from work other than meal breaks.
Employee must be available by teams, phone, and email during work hours.
Employee must be available to attend required training and meetings via teams.

Responsibilities

Ensure all records are maintained in absolute integrity and in compliance with applicable regulations and requirements.
Obtaining or updating required referrals and authorizations via phone, fax, on-line, etc.
Review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification.
Data entry in a fast-paced environment with high expectations on accuracy.
Updates the patient account with details of the insurance verification.
Coordinating with patients regarding their insurance benefits.
Identifies deductibles, co-pays, and self-pay accounts.
Notifying the appropriate staff members if treatment or service is denied.
Assist manager and other staff with account questions when presented.
Perform other duties as assigned.
Rely on experience and judgment to plan and accomplish goals.