Insurance Verification Specialist
2 months ago
***This position will be remote after 2-3 weeks of onsite training at our Oakbrook office)***
Purpose:
Insurance Verification Specialists are primarily responsible for working with insurance companies and medical billing staff to manage the eligibility and benefits process. Specialize in tasks related to ensuring that the company is paid appropriately for their services, and insurance verification requests are done accurately and efficiently.
Duties & Responsibilities:
- Verify eligibility and benefits using electronic database/clearinghouse and via telephone.
- Review documentation for coding compliance and medical necessity.
- Manages and coordinates all Insurance benefits to ensure patient responsibility.
- Prepare insurance verification response to providers.
- Telephone communication with payers to verify eligibility, benefits, prior authorization.
- Experience with payer websites, electronic clearinghouses, Availity
- Medical coding
- Review records, coding, and billing practices to ensure compliance.
- Initiate prior authorizations.
- Communicate with providers and internal staff regarding insurance verifications and patient benefits.
- Follow up on prior authorizations.
- Assist with claim follow up, billing onboarding, and calls to providers to educate offices on billing for the products.
Skills & Abilities:
- Ability to interpret medical benefits.
- Must have strong attention to detail skill, highly accurate and must possess organizational skills.
- Excellent communication and documentation skills required.
- Ability to discuss patient benefits with providers, medical staff, and sales personnel.
- Solid understanding of Medicare LCDs and commercial medical policies.
- Knowledge of CPT, HCPCS, and ICD10 coding and medical terminology.
- Proficient in Word, Excel, computer entry (required)
- Experience in precertification, insurance verification, and some medical billing.
Education & Experience:
- High School Diploma or Equivalent (required)
- 2+ years previous insurance eligibility verification experience (required)
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