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Insurance Verification Specialist
3 months ago
Insurance Verification Specialist
Plano, TX USA 75024
06 Months
Skills: Understanding of Medicare rules and regulations; understanding of managed care as it relates to benefits and authorizations; advanced MS Office experience; strong verbal and written communication skills; Education: min. HS diploma or GED equivalent
• Minimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experience
• Knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
• Experience in medical device or DME Billing a plus
• Proficient with Microsoft Office (Word & Excel specifically)
• Medical billing software experience a plus
• Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding)
• Ability to accurately meet required time frames/deadlines
• Ability to work as a team player and share workloads with other team members
• Excellent verbal and written communication skills
• Ability to train/present concepts to others
Duties: Contacts insurance companies to verify insurance benefits; initiates pre-authorization requests for new and ongoing services with insurance companies and performs follow up activities for an outcome; files Appeals for denied coverage to insurance companies as needed; maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance company; coordinates and communicates with other departments as needed to obtain necessary information to complete benefit verification, authorization, appeals and outcomes for services of care; provides customers with information that includes but is not limited to: updates on status of authorizations, developing & communicating patient financial responsibility estimates, and collecting co-pays, if applicable; applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes; performs other related duties as assigned.
