Insurance Verification Specialist Job Description
Insurance Verification Specialist Duties & Responsibilities
To write an effective insurance verification specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included insurance verification specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Insurance Verification Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Insurance Verification Specialist
List any licenses or certifications required by the position: CHAA
Education for Insurance Verification Specialist
Typically a job would require a certain level of education.
Employers hiring for the insurance verification specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and High School Degree in Business, Associates, Education, Accounting, Medical, Business/Administration, Healthcare, Accountancy, Medical Billing & Coding, Computer Sciences
Skills for Insurance Verification Specialist
Desired skills for insurance verification specialist include:
Desired experience for insurance verification specialist includes:
Insurance Verification Specialist Examples
Insurance Verification Specialist Job Description
- Coordinate efforts to increase access to & awareness of CGM with Insurance Companies
- Review payer document requirements and provide the Regional Account Directors with data to support broader access to CGM therapy
- Producing Independent Pricing Verification of Insurance Solutions products (Pensions, life settlement, XXX/AXXX)
- Analysing complex pricing
- Communicating effectively with Management, the Trading Desk, Market Risk and Finance
- Ensuring Process Improvement
- Training and management of junior team members
- Working on projects within the wider group and cross functions
- Secure appropriate patient account reimbursement by obtaining complex demographic, insurance, and medical information
- Identify services requiring authorization for treatment, and ensuring the required authorizations are in place
- Must be able to handle multiple tasks and organize multiple files simultaneously
- Must be able to handle a high volume of orders
- Must be able to manage timely follow up on all prior authorizations and remain diligent until a determination is received
- Ability to think in an anticipatory way, one step ahead of the process
- Must know how to prioritize patient files on a daily and monthly basis
- Be able to work with monthly quotas, quarterly quotas, yearly quotas
Insurance Verification Specialist Job Description
- Obtain financial verification and pre-certification as required for patients’ visits
- Locate, and verify current insurance and demographic information for patient and/or guarantor
- Document financial and pre-certification information according to defined process in a timely manner
- Assist with review and follow up of denials and payment discrepancies identified through the denial system which are directly related to the verification and authorization process
- Follow up with insurance, physicians, and any other area that can validate and assist with actions and information needed in order to properly review, dispute or appealing denial
- Maintain timely and efficient follow up on successfully submitted appeals until a determination is made on the appeal
- Verify insurance coverage for changes in medication orders
- General knowledge of insurance terms and coverage preferred
- Collects and reviews all patient insurance information needed to complete the benefit verification process
- Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs
- Will need to know how to manage their time based on time of month, knowing when getting new patients is priority, when getting documentation is priority and shipping CGM’s is priority
- Some knowledge of the Insurance business or strong knowledge of structured finance / structured credit products
- Visual Basic Access and database experience (beneficial)
- Knowledge of Intex and Trepp
- Management experience (beneficial)
- Ability to motivate to enhance current processes
Insurance Verification Specialist Job Description
- Identifies any restrictions and details on how to expedite patient access
- Could include documenting and initiating prior authorization process, claims appeals
- Completes quality review of work as part of finalizing product
- Reports any reimbursement trends/delays to supervisor
- Work requires focus, flexibility, and the ability to adapt to changing work situations
- This position requires that the Associate be seated most of the day
- Ensures all necessary demographic, clinical, billing and insurance information is entered in patients record, follows up with patient and updates information as needed
- Serves as an insurance and coverage resource as needed, by working with the clinics to provide a smooth check in process for the patient
- Scans assignment of benefits, verification of benefits information and financial liability and forwards completed information back to the appropriate office
- Precertification Specialist must update patient accounts with registration, insurance, demographic, scheduling, and billing data
- Knowledge of required documentation which can include
- Minimum of 2+ years knowledge of Insurance benefits which includes deductibles, Co-Insurance, out of pocket, exclusions, and Prior Authorization requirements
- Ability to demonstrate an attention to detail with an understanding of key derivative valuation issues
- Handle multiple tasks and organize multiple files simultaneously
- Work with Insurance Verifier to assure that follow ups completed timely and offer assistance as needed
- Think in an anticipatory way - be one step ahead of the process
Insurance Verification Specialist Job Description
- Verifies insurance eligibility and benefits and ensures all notifications and authorizations are
- Verify information on incoming documents for accuracy
- Scan and upload documents from insurance providers into electronic records system
- Submit changes to patient prescriptions in the system
- Obtain authorization for payment
- Should have EMR experience
- Retrieves demographic information from schedule posting and enters the information in database
- Communicates with physician offices, insurance carriers and patients to obtain the most current and updated information
- Verifies patient insurance coverage via phone/or online for surgery procedures
- Determines if referrals or authorizations are required for specified procedures
- Know how to prioritize patient files on a daily and monthly basis
- Manage your time based on time of month, knowing when getting new patients is priority, when getting documentation is priority and shipping CGM’s is priority
- 2-3 year of office experience, preferably in a healthcare setting
- Minimum of 2 years of medical business office experience with insurance procedures and patient interaction
- Ability to be careful and thorough.• Ability to build relationships both in person and over the phone.• Ability to work proficiently with company software used on the project
- Primarily sedentary work in a general office environment• Ability to communicate and exchange information• Ability to comprehend and interpret documents and data• Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)• Requires manual dexterity to use computer, telephone and peripherals• May be required to work extended hours for special business needs• May be required to travel at least 10% of time based on business needs
Insurance Verification Specialist Job Description
- Offers facility payment options to patients when applicable
- Responsible for performing registration functions of patient admissions, including reviewing all information with patient, completing appropriate forms, and copying appropriate insurance cards and photo identification
- Performs insurance pre-certification, verification, and interviews patients prior to surgery
- Reviews the insurance contract profiles in AdvantX and manages reimbursement process
- Performs collections, reconciliation, and follow up activities timely on all accounts
- Schedules patient surgical procedures and maintaining the surgery schedule
- Utilize initial referral form to determine if additional information will be needed in order to complete verification of benefits
- Verify insurance coverage for all assigned patients
- Ensure procedure is covered under the patient’s plan and guidelines
- Accurately code insurance in the billing system to ensure timely billing
- Requires excellent telephone etiquette, computer, customer service and organizational skills
- Will cross train in other areas
- Obtain prior authorizations with insurance companies
- Following up on status of authorizations
- Communicating information to the admissions team timely
- Maintain efficient tracking of all pending authorizations to ensure timely resolution and avoid loss of revenue