Insurance Verification Specialist

Responsible for determining patient's primary, secondary and tertiary insurance payer; verify patients' benefits, eligibility, and seek authorization for services by contacting insurance companies; determine patient financial impact, if any, and inform them of any possible financial responsibility.

Major Areas of Accountability

• Responsible for the timely verification of medical insurance benefits for new patients, existing patients with changes in insurance, and reactivated patients.
• Review and update patient accounts with insurance policy information and process requests accurately.
• Notate each account with a clear summary of patient eligibility and insurance benefits received from the carrier.
• Call government funded and commercial insurance companies to obtain prior authorizations or referrals.
• Determine the correct Coordination of Benefits.
• Complete verification requests confirming the correct network status through the company's contracts with insurance payers to determine member benefit coverage.
• Ensure all insurance, demographic and eligibility information is obtained, and entered in the system in an accurate manner.
• Responsible for reviewing customer files for missing insurance information required to bill for services rendered.
• Perform financial review on existing accounts to identify benefit issues.
• Assist in maintaining inbound faxes, manuals, logs, and other documentation as required.
• Complete insurance verification and summary of reimbursement, and liability forms.
• Advise the Manager of verification trends and updates.
• Meets individual, departmental, and company goals.
• Other duties as assigned.
• Occasionally, employees currently recognized as high performers through recent performance evaluations, or employees with current demonstrated productivity leadership compared to other employees on existing metrics may be asked to engage in overtime.

Basic Qualifications

• High school diploma
• Medical terminology
• Two years' experience in medical insurance plans or benefit verification practices
• Excellent written and verbal communication skills
• Ability to read and understand explanations of medical benefits
• Medi-Cal or West-coast payer knowledge preferred