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Insurance Verification Specialist

1 month ago

Conshohocken, United States Extremity Care Full time

**This is an hybrid position in our Conshohocken office**

**Purpose**:
Reimbursement Specialists are primarily responsible for working with insurance companies and medical billing staff to manage the billing/reimbursement process. Specialize in tasks related to ensuring that the company is paid appropriately for their services.

**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 knowledge
- 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 attentive to detail, accuracy 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)
- Medical Billing or Coding Certification (preferred)
- Experience in medical billing, precertification, and insurance verification.

**Education & Experience**:

- High School Diploma or Equivalent (required)
- 2-3 years previous medical billing experience (required)

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