Senior Insurance Verification Specialist

Adapthealth • Beaver, PA

96d

About The Position

At AdaptHealth, we offer full-service home medical equipment products and services to empower patients to live their best lives - out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients' lives, please click to apply, we would love to hear from you. The Insurance Verification Specialist is responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Insurance Verification Specialist works in a fast-paced environment answering inbound calls and making outbound calls. They may be responsible for obtaining, analyzing, and verifying the accuracy of information received from referrals, creating orders, and scheduling the patient to receive equipment as ordered by their doctor. Insurance Verification Specialists should educate patients about their financial responsibility when applicable.

Requirements

• High School Diploma or equivalent.
• One (1) year work-related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment.

Nice To Haves

• General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.

Responsibilities

• Develop and maintain working knowledge of current products and services offered by the company.
• Review all required documentation to ensure accuracy.
• Maintain an extensive knowledge of different types of payer coverage and insurance policies.
• Verify patient insurance coverage to ensure necessary procedures are covered accurately.
• Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
• Obtain pre-authorization if required by an insurance carrier and process physician orders for approval and authorization.
• Resolve any issues with coverage and escalate complicated issues to a Manager.
• Complete accurate patient demographic and insurance entry into EMR databases.
• Communicate with Customer Service and Management regarding trends with insurance companies.
• Verify insurance carriers are listed in the company's database system and request new entries if needed.
• Contact patients when documentation does not meet payer guidelines to provide updates and options.
• Meet quality assurance requirements and other key performance metrics.
• Facilitate resolution on customer complaints and problem solving.
• Utilize company provided tools to maintain quality.

What This Job Offers

• Career Level: Entry Level
• Industry: Merchant Wholesalers, Durable Goods
• Education Level: High school or GED