Insurance Verification Spec 1 [United States]

 

JOB SUMMARY

The Insurance Verification Specialist 1, under general supervision, provides patients, physicians and internal hospital personnel with insurance benefit information. This position ensures timely verification of insurance benefits and financial clearance which has a direct impact to the organization's reimbursement from payers for patient accounts that are scheduled and unscheduled.

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Hours: M-F 8:30am-5:00pm

ESSENTIAL FUNCTIONS OF THE ROLE

• Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.
• Completes appropriate payor forms related to notification and authorization.
• Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
• Calculates accurate patient financial responsibility.
• Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patient's account prior to scheduled or unscheduled service during the patient's hosptial stay.
• Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.

KEY SUCCESS FACTORS

• 1 year of healthcare or customer service experience preferred.
• Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
• Ability to know and adhere to payer guidelines by plan and service type.
• Requires good listening and communication skills, and professional telephone etiquette.
• Ability to maintain a professional demeanor in a highly stressful and emotional environment, behavioral health and/or suffering patients in addition to life or death situations.
• Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills.
• Basic computer skills and Microsoft Office.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - Less than 1 Year of Experience

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