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Insurance Verification

4 months ago

New York, United States Vitreous-Retina-Macula Consultants of New York PC Full time
Job DescriptionJob Description
  • 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
Qualifications:
  • 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. 

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