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Insurance Verification Clerk
2 months ago
- Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
- Insurance Verification determine if Participating in net work or out of Network- confirmed Members Benefits for services being rendered
- Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
- Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
- Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
- Coordinates with Providers and Members regarding authorization requests and/or activities
- Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
- Reviews all authorization requests for accuracy and prioritizing based on urgency
- Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
- Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
- Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Performs other duties and special projects, as assigned
Experience Requirement:
- Entry Level willing to train
- Knowledge of CPT and ICD9/ICD10 coding/ Clinical.
- Understanding of insurance plans, i.e. HMO, POS, PPO
- Knowledge of Excel and Word
- Excellent Organizational Skills; Attention to Detail
- Exceptional Communication Skills
- Working Knowledge of Insurance Company Operations and Procedures
- Excellent customer service skills
- Ability to prioritize work in a fast-paced environment
- Computer skills
- Appeals/Retro active request skills
- Sending Specialty Prescription when needed
- MRI Authorization Utilization Management
- Knowledge of Manufacture Co-Pay Assistance Program/Foundation.
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- 401k
- 401k matching
- Flexible Spending Account
- Aflac
- Optum Transit
- Paid time off
- Parental Leave
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