Insurance Verification Specialist

5 months ago

Atlanta, United States Shepherd Center Full time

Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, stroke, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions.

Join us in our mission to help people with a temporary or permanent disability, rebuild their lives with hope, independence and dignity, advocating for their full inclusion in all aspects of community life.

At Shepherd Center, you’ll discover a diverse and inclusive environment, enlightened leadership, a culture of teamwork, professionalism and mutual respect. If you are seeking career advancement, continuing education opportunities coupled with a welcoming and fun workplace, competitive compensation and employment benefits, visit our to explore current openings.

The Insurance Verification Specialist plays a key role in the patient financial experience by coordinating insurance and benefits verification, pre-certification, and pre-authorization for patients at Shepherd Center, often handling cases that need quick turnaround. The role is knowledgeable on payer regulations and contracts and serves as a point of contact for peers seeking resolution to questions and/or issues.

JOB RESPONSIBILITIES

The Insurance Verification Specialist performs various duties in order to improve the patient financial experience.

Leads and develops training for new staff members.

Verifies benefits and obtains proper billing address and phone number for carrier.

Identifies and obtains information on liability policies which may be a source of payment, including but not limited to, auto, homeowners, commercial liability policies.

Assigns payer plan codes in organization’s electronic health record system; utilizes knowledge of insurance plans and contracts to identify opportunities to improve payer master file.

Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, and secure pre-authorizations before scheduled appointment date.

Ensures all required clinical documentation is obtained and submitted for timely pre-certification.

Serves as point of contact for addressing account issues, patient concerns, or billing and insurance questions before they are escalated to a supervisor or manager.

REQUIRED MINIMUM EDUCATION

High school diploma or GED required

Associate or Bachelor’s degree preferred in healthcare administration or related field preferred

REQUIRED MINIMUM CERTIFICATION

Certified Healthcare Access Associate (CHAA) certification required

Certified Patient Account Representative (CPAR) certification required

REQUIRED LICENSURE

N/A

REQUIRED MINIMUM EXPERIENCE

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.

Must understand benefit levels, how they’re applicable to Shepherd Center’s array of services, and convey these to Case Managers and Clinical Managers.

Must understand the concepts around discerning between TPAs, networks, how to determine network status, and coordination of benefits rules as they apply to individual patient’s coverages.

Must understand and effectively coordinate benefit plans’ various provisions for accessing drugs (buy and bill/bagging, etc.), payers’ patient programs, SC charity programs, etcetera regarding high cost drugs’ coverages.

Must interpret and understand medical criteria guidelines within payers’ utilization policies to be certain Shepherd Center has provided all necessary data to obtain authorizations.

Experience in automated systems, overall knowledge of business office procedures and hospital policy, knowledge of third-party payors.

Excellent communication and customer service skills.

Familiar with general office equipment.

REQUIRED MINIMUM SKILLS

Must have a working knowledge of PC spreadsheet and database software.

Strong math aptitude required.

PREFERRED QUALIFICATIONS

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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