Insurance Specialist

1 week ago

Atlanta, Georgia, United States Shepherd Center Full time
Job Title: Insurance Verification Specialist

Shepherd Center is seeking a highly skilled Insurance Verification Specialist to join our team. As a key member of our patient financial services team, you will play a critical role in ensuring seamless insurance and benefits verification, pre-certification, and pre-authorization for patients.

Responsibilities:
  • Coordinate insurance and benefits verification, pre-certification, and pre-authorization for patients.
  • Develop and lead training for new staff members.
  • Verify benefits and obtain proper billing address and phone number for carriers.
  • Identify and obtain information on liability policies that may be a source of payment.
  • Assign payer plan codes in our electronic health record system and utilize knowledge of insurance plans and contracts to identify opportunities to improve payer master file.
  • Utilize online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, and secure pre-authorizations before scheduled appointment dates.
  • Ensure all required clinical documentation is obtained and submitted for timely pre-certification.
  • Serve as a point of contact for addressing account issues, patient concerns, or billing and insurance questions before they are escalated to a supervisor or manager.
Requirements:
  • High school diploma or GED required.
  • Associate or Bachelor's degree preferred in healthcare administration or related field.
  • Certified Healthcare Access Associate (CHAA) certification required.
  • Certified Patient Account Representative (CPAR) certification required.
  • Minimum of two years' professional experience in an outpatient setting, rehabilitation center, or as an external case manager.
  • Knowledge of Commercial, Managed Care Contracts, and Governmental Insurance Plans.
  • Excellent communication and customer service skills.
Preferred Qualifications:
  • Experience in automated systems, overall knowledge of business office procedures, and hospital policy.
  • Knowledge of third-party payors.
  • Strong math aptitude required.

Physical Demands: Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Working Conditions: Some potential for exposure to blood and body fluids.

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