Insurance Verification Specialist

Job Description: Insurance Verification Specialist

Reports To:  Accounts Receivable and Billing Manager

Department: Accounting

Position Summary

Overall responsibility for ensuring that patient health care benefits cover required procedures. This individual contacts a patient’s insurance company to verify coverage levels and works with individuals to educate them on their benefits information. Additionally, this individual works to meet State and Federal Regulatory guidelines, and complies with agency policies and procedures. Ensures the duties are completed in a timely and proper manner.

Position Qualifications:

  • High School graduate or equivalent. Associate’s or more advanced degree preferred
  • One year experience in a medical office, hospital, outpatient clinic, or other health care settings.       Home health or hospice experience preferred
  • Knowledge of medical terminology
  • Minimum of one-year insurance verification experience with knowledge of CPT and HCPCS coding
  • Computer literacy
  • Intermediate typing skills
  • Knowledge of office machines
  • Excellent phone skills with an emphasis on customer service
  • Organizational skills
  • Must have experience working with insurance companies, have extensive knowledge of different types of coverage and policies
  • Ability to multi-task, detail oriented, organized ability to maintain accurate records, work quickly to process items in a timely manner, work well with others

Duties:

  • Insurance Verification Specialist is responsible for obtaining verification of patient payer benefits and eligibility for the homecare services ordered. Includes Private Insurance, Veteran’s Association, Medicare/Medicaid
  • Ongoing written and verbal communication with case managers regarding authorization, re-authorization, and retro-authorization of visits
  • Provide payers with verbal or faxed clinical status reports, etc. as needed
  • Provide accurate documentation of conversations regarding patients
  • Working knowledge of specific contracts between the agency and various payers
  • Insures that cases are effectively managed according to utilization and authorization, as defined by payer. This function includes: documentation and ongoing maintenance of authorization and re-authorization
  • Acting as a resource to patients and communicating as appropriate with other family members involved in patient care re insurance coverage
  • Utilizes sound customer service principles in relating to patients by negotiating effectively, resolving conflicts, seeking management assistance as appropriate, and responding as appropriate and communicating the agency’s spectrum of care
  • Verify Medicare eligibility via Ability website. Recognize “Option C” coverage and Medicare Secondary and obtain appropriate authorization for services
  • Verify Medicaid coverage, report to “Medicaid Specialist” new Medicaid referrals
  • Scan insurance documents as needed for “Accounts Receivable and Billing Manager”
  • Works under the direction of “Accounts Receivable and Billing Manager”, assist with duties as directed
  • Process new intakes/referrals as requested
  • Electronic and paper filing, including but not limited to patient and insurance company correspondence
  • Answer incoming calls as needed
  • Other duties as assigned

Contacts:  Families, insurance companies, staff members, hospital/facility personnel

Physical Demands: Physical exertion—walking, lifting, pulling, computer work

Environmental Conditions: Exposed to products used in the office, i.e, printers, computers, dust, etc.

Working Conditions: Periods of stress—variable workloads and deadlines

 

HomeCare & Hospice of the Valley is an equal employment opportunity employer committed to non-discriminatory employment practices and patient services.

Non-exempt position

April 2014