Insurance Verification Specialist

5 days ago

Houston, Texas, United States Premier Medical Resources Full time
Job Title: Insurance Verification Specialist

Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. Our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. We strive to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence.

Job Summary:

We are seeking a highly skilled Insurance Verification Specialist to join our team. The successful candidate will be responsible for verifying patient insurance coverage, ensuring surgery and procedures are covered by an individual's insurance plan. They will create cost estimates prior to the surgery date and communicate cost to patients. Additionally, they will enter and verify accurate data and update patient benefit information in the Electronic Medical Records (EMR).

Key Responsibilities:
  • Assist front office with verification questions or concerns
  • Resolve any coverage issues and update patient EMR
  • Enter insurance coverage (co-payments, deductibles, etc.) accurately into patient EMR
  • Serve as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts
  • Verify patient insurance coverage and benefits through online portals, phone calls, and other resources
  • Verify insurance eligibility along with benefits and ensure all notifications and authorizations are completed by the surgery date
  • Identify patient accounts based on self-pay, PPO, HMO, personal injury, workmen's compensation or other managed care organizations
  • Collect relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders
  • Communicate with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained
  • Respond to inquiries regarding patient accounts with appropriate and accurate information in a professional manner
  • Ensure accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information
  • Create financial arrangements, alongside management, when a patient is unable to complete payment
  • Respond promptly to requests and keep open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
  • Collaborate with billing and coding departments to ensure correct processing of claims
  • Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
  • Complete high-quality work while adhering to productivity standards
  • Perform miscellaneous job-related duties as assigned
Requirements:
  • Demonstrate ability to use basic computer functions, technology and Microsoft office (excel, word)
  • Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations
  • Ability to work independently with little or no supervision as well as function within a team
  • Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization
  • Good communication skills (verbal / written) providing a great patient experience
  • Ability to work effectively in a fast-paced environment
  • Strong knowledge of managed care, medical terminology, CPT Coding and ICD10
  • Demonstrate use of appropriate modifiers, HIPAA regulations, and insurance verification procedures
  • Knowledge of payor guidelines including reading, understanding and interpreting medical records and payor requirements etc.
  • Ability to think critically, assess problems and provide problem resolutions
  • Demonstrate attention to detail, accountability, people skills, problem solving and decision-making skills
Education and Experience:
  • High School Diploma or GED
  • One (1) year of hospital revenue cycle experience
  • One (1) year of general customer service experience
Benefits:
  • 3 Medical Plans
  • 2 Dental Plans
  • 2 Vision Plans
  • Employee Assistant Program
  • Short- and Long-Term Disability Insurance
  • Accidental Death & Dismemberment Plan
  • 401(k) with a 2-year vesting
  • PTO + Holidays

Please visit our website for more information:

Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.

Job Posted by ApplicantPro

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