VOB Specialist - PCP

the Client•Lake Mary, FL

1d•Onsite

About The Position

The VOB Specialist assists patients by ensuring accurate insurance information is on file and obtaining required authorizations or PCP referrals. The role verifies insurance benefits, requests and follows up on pre-authorizations, PCP referrals, and Letters of Agreement, and files appeals for denied coverage when needed. It maintains benefit-related customer records in the practice management system and coordinates with other departments to gather information needed for benefit verification, authorizations, appeals, and service outcomes. The specialist communicates with customers about authorization status, estimated financial responsibility, and applicable co-pays. The role applies company procedures and contracted and non-contracted guidelines when processing cases and updating records. This is an onsite, six-month contract role in Lake Mary, Florida, scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m. The position is explicitly described as a verification-of-benefits role, not a customer service role, and requires prior authorization or verification experience.

Requirements

High school diploma or GED.
At least one year of experience in insurance benefits verification, collections, or managed care contracting.
Prior authorization or verification experience.
Excellent verbal and written communication skills, including the ability to communicate effectively with internal and external customers.
Ability to work under pressure, meet deadlines, maintain a positive attitude, and provide exemplary customer service.
Ability to work independently and complete assignments within the parameters of given instructions, routines, and accepted practices.
Understanding of benefit verification or collections as related to policies and procedures for effective placement of medical services.
Complete understanding of Medicare rules and regulations.
Understanding of managed care as it relates to benefits and authorizations.
Ability to work at a computer workstation for extended periods.
Authorization to work for any U.S. employer; the employer is unable to sponsor or take over sponsorship of an employment visa.

Nice To Haves

Associate's degree.
Two or more years of experience in insurance benefits verification, collections, or managed care contracting.
Knowledge of medical insurance.
Knowledge of contracting and fee schedules.
Strong computer and software skills.
Advanced Microsoft Office experience, especially Microsoft Excel.
Continued self-improvement courses and seminars related to the position, along with participation in client-provided in-house programs.

Responsibilities

Contact insurance companies to verify insurance benefits.
Initiate pre-authorization, PCP referral, and Letter of Agreement requests for new and ongoing services, and follow up with insurance companies for outcomes.
File appeals with insurance companies for denied coverage as needed.
Maintain practice management system records concerning benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes, and communications with insurance companies.
Coordinate and communicate with other departments to obtain information needed to complete benefit verification, authorizations, appeals, and service outcomes.
Provide customers with authorization status updates and estimates of patient financial responsibility, and collect applicable co-pays.
Apply company procedures and contracted and non-contracted guidelines to process cases and respond to correspondence and documentation.
Update customer records according to case outcomes.
Perform other related duties as assigned.