Insurance Verification Specialist Job Description

Insurance Verification Specialist Job Description

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Insurance verification specialist provides education and training for Senior Nurse Advocates and Nurse Advocates on the intricacies of insurance plans including Medicare and state Medicaid.

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:

When other Insurance Verification Specialists are absent or not available, provides backup coverage for their territories
Computer skills in outlook, Word, and Excel
Calling Insurance payors, following up with Clients and Patients regarding financial obligations
Maintain insurance authorizations for current patients
Re-verify insurance coverage for changes in medication orders
Research and follow up on authorization denials
Work closely with branch staff to collect additional information on Physician Orders
Submit changes to patient prescriptions in the system and obtain authorization for payment
Maintain insurance authorizations for current patients receiving high dollar medications
Processes opportunities staged and statused under Managed Care responsibilities within OSR Expectations, such as verifying benefits, requesting authorization, & following up on auth-requests

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:

State
Federal
Accreditation regulations governing home care
Medicaid and commercial carriers
Billing activities
Medicare and Non-Medicare Home Health payor requirements
Excel
Insurance verification
Insurance authorization
Medical insurance/authorization process

Desired experience for insurance verification specialist includes:

Complete data fields within ERP system with insurance benefit information, including risk entity, estimated Out Of Pocket expenses, deductible met, authorization start & end dates, and others
Prepares correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement
Clearly documents all correspondence in the company databases
May help to create, provide or request forms to collect clinical data on patients
Troubleshoots and seeks solutions to problems related to questions and concerns over health insurance coverage and explanation of benefits, orders and sales efforts
May be required to explain Continuous Glucose Monitoring System (CGMS) insurance benefits coverage to payers, discuss how it works, and describe the functions and supplies that go with CGMS

Insurance Verification Specialist Examples

1

Insurance Verification Specialist Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of insurance verification specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance verification specialist
  • 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
Qualifications for insurance verification specialist
  • 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
2

Insurance Verification Specialist Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of insurance verification specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for insurance verification specialist
  • 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
Qualifications for insurance verification specialist
  • 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
3

Insurance Verification Specialist Job Description

Job Description Example
Our company is growing rapidly and is hiring for an insurance verification specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for insurance verification specialist
  • 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
Qualifications for insurance verification specialist
  • 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
4

Insurance Verification Specialist Job Description

Job Description Example
Our growing company is looking for an insurance verification specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for insurance verification specialist
  • 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
Qualifications for insurance verification specialist
  • 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
5

Insurance Verification Specialist Job Description

Job Description Example
Our company is growing rapidly and is hiring for an insurance verification specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance verification specialist
  • 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
Qualifications for insurance verification specialist
  • 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

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