Health Insurance Verification Specialist
4 weeks ago
**Location**:New Berlin, US**Job Family**:Finance**Country/Region**:United States**Health Insurance Verification Specialist **| Atos Medical-US | New Berlin, WI**
**This position is remote but requires you to be commutable to New Berlin, WI for orientation and training/employee events as needed.**
**Join a growing company with a strong purpose**
- Do you want to make a difference for people breathing, speaking and living with a neck stoma? At Atos Medical, our people are the strength and key to our on-going success. We create the best customer experience and thereby successful business through our 1200 skilled and engaged employees worldwide.**About Atos Medical**
- Atos Medical is a specialized medical device company and the clear market and technology leader for voice and pulmonary rehabilitation for cancer patients who have lost their voice box. We design, manufacture, and sell our entire core portfolio directly to leading institutions, health care professionals and patients. We believe everyone should have the right to speak, also after their cancer. That’s why we are committed to giving a voice to people who breathe through a stoma, with design solutions and technologies built on decades of experience and a deep understanding of our users.- Atos Medical has an immediate opening for a **Health Insurance Verification** Specialist in the Insurance Department.**Summary**
- The Health Insurance Verification Specialist will support Atos Medical’s mission to provide a better quality of life for laryngectomy customers by assisting with the attainment of our products through the insurance verification process and reimbursement cycle. A successful Health Insurance Verification Specialist in our company uses client information and insurance management knowledge to perform insurance verifications, authorizations, pre-certifications, and negotiations. The Health Insurance Verification Specialist will analyze and offer advice to our customers regarding insurance matters to ensure a smooth order process workflow. They will also interact and advise our internal team members on schedules, decisions, and potential issues from the Insurance payers.**Essential Functions**
- Act as an advocate for our customers in relation to insurance benefit verification.
- Obtain and secure authorization, or pre-certifications required for patients to acquire Atos Medical products.
- Verifies the accuracy and completeness of patient account information.
- Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers. Follows up with physician offices, customers and third-party payers to complete the pre-certification process.
- Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity.
- Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
- Answer incoming calls from insurance companies and customers and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner.
- Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
- Verifies that all products that require prior authorizations are complete. Updates customers and customer support team on status. Assists in coordinating peer to peer if required by insurance payer.
- Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify customer support team if authorization/certification is denied.
- Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
- Inquire about gap exception waiver from out of network insurance payers.
- Educate medical case reviewers at Insurance Companies about diagnosis and medical necessity of Atos Medical products.
- Obtaining single case agreements when requesting an initial authorization with out of network providers. This process may entail the negotiation of pricing and fees and will require knowledge of internal fee schedules, out of network benefits, and claims information.
- Complete all Insurance Escalation requests as assigned and within department guidelines for turn around time.
- Maintains reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
- Other duties as assigned by the management team.
**Basic Qualifications**
- High School Diploma or G.E.D
- Experience in customer service in a health care relate
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