Insurance Eligibility Verification Specialist

2 months ago

Mount Laurel, United States Pinnacle Treatment Centers, Inc. Full time
Job DescriptionJob Description

Insurance Eligibility Verification Specialist

Remote

We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth.

Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 30,000 patients daily.

Our mission is to remove all barriers to recovery and transform individual, families, and communities with treatment that works.

Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment.

As an Insurance Verification Specialist, you will work as an advocate for patients and facilities as well as a liaison between operations and RCM. You will serve as a gatekeeper of the incoming and outgoing verification of benefits. You will be responsible for obtaining insurance benefits, verifying of eligibility status including but not limited to providing ongoing education for staff within the facilities. You will also be responsible for collecting accurate demographic and insurance information for the revenue cycle data entry team.

Requirements:

  • High school diploma or GED (General Equivalency Diploma).
  • Understanding of federal or state government agencies including Social Security, Medicaid and/or Commercial coverages, familiar with the healthcare revenue cycle touching patient accounts.
  • 6+ months of experience in a customer service role, interacting directly with customers either in-person or over the phone.
  • 6+ months of experience working in a role with a high volume of either inbound or outbound calls.
  • Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievements of performance metrics.
  • Demonstrated experience communicating effectively with others and simplifying complex information.
  • Demonstrated ability to navigate Internet Explorer and Microsoft Office. Ability to problem solve simple technology issues.
  • Experience with customer interactions that require live, accurate documentation of the encounter.
  • Ability to handle sensitive information and maintain HIPAA (Health Insurance Portability and Accountability) compliance.
  • Ability to work the required facility holidays.
  • Proven time management skills.
  • Previous experience collecting patient payments or copays.
  • Understanding of various eligibility systems
  • Up to 10% travel.

Responsibilities:

  • Responsible for verifying patients’ insurances, as well as their covered benefits and for confirming pre-authorizations for services.
  • Works well as part of a team and effectively communicates. Assists practice staff with eligibility, as necessary.
  • Serves as a liaison between the RCM department and the various PTC facilities.
  • Handle high volume of inbound/outbound calls for patients that need to be screened financially and medically for financial assistance.
  • Complete verification of benefits for multiple clients within the appropriate timelines.
  • Maintains high quality customer service standards in compliance with federal and state regulations and guidelines. Provide periodic processing status updates.
  • Assist in researching reimbursement issues relevant to benefits/eligibility issues.
  • Assist in training of new team members.
  • Enter and update patient demographics into the billing system as needed.
  • Complete KPI reports as requested by management and the clients.
  • Update and manage the VOB tracker for multiple clients.
  • Understand federal and state requirements regarding client confidentiality and the principles of maintaining protected health information (PHI).
  • Work effectively and maintain expected productivity.
  • Other tasks or duties as assigned
  • Supports front desk by educating them on accurate demographic and insurance entry

Benefits:

  • 18 days PTO (Paid Time Off)
  • 401k with company match
  • Company sponsored ongoing training and certification opportunities.
  • Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance.
  • Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP)
  • Discounted tuition and scholarships through Capella University

Join our team. Join our mission.

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