Insurance Verification Specialist

2 months ago

Atlanta, Georgia, United States Shepherd Center Full time
Job Summary

The Insurance Verification Specialist plays a pivotal role in the patient financial experience at Shepherd Center, a leading private, not-for-profit hospital specializing in medical treatment, research, and rehabilitation for individuals with spinal cord injury, brain injury, stroke, multiple sclerosis, spine, and chronic pain, as well as other neuromuscular conditions.

Key Responsibilities
  • Coordinate insurance and benefits verification, pre-certification, and pre-authorization for patients, ensuring timely and accurate processing.
  • Develop and lead training programs for new staff members, promoting knowledge sharing and best practices.
  • Verify benefits and obtain proper billing information for carriers, ensuring seamless communication.
  • Identify and obtain information on liability policies, including auto, homeowners, and commercial liability policies, to explore potential sources of payment.
  • Assign payer plan codes in the organization's electronic health record system, utilizing knowledge of insurance plans and contracts to optimize payer master files.
  • Utilize online systems, phone communication, and other resources to verify eligibility and benefits, determine coverage extent, and secure pre-authorizations before scheduled appointments.
  • Ensure all required clinical documentation is obtained and submitted for timely pre-certification, maintaining compliance with regulatory requirements.
  • Serve as a point of contact for addressing account issues, patient concerns, or billing and insurance questions, providing exceptional customer service and resolving issues efficiently.
Requirements
  • High school diploma or GED required; Associate or Bachelor's degree in healthcare administration or a related field preferred.
  • Certified Healthcare Access Associate (CHAA) and Certified Patient Account Representative (CPAR) certifications required.
  • Minimum of two years' professional experience in an outpatient setting, rehabilitation center, or as an external case manager, with knowledge of commercial, managed care contracts, and governmental insurance plans.
  • Strong understanding of benefit levels, coordination of benefits rules, and medical criteria guidelines within payers' utilization policies.
  • Excellent communication and customer service skills, with the ability to work effectively in a team environment.
  • Familiarity with general office equipment and automated systems, with a strong math aptitude.

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