Insurance Verification Specialist
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Receive assigned insurance verification requests (IVRs) from data intake; call Health Plan to obtain benefit coverage levels and prior authorization requirements to determine payer reimbursement; submit required preauthorization/predetermination paperwork to payer
Initiate contact with Health Plan and follow-up on benefit coverage requests and prior authorizations; identify and escalate issues as they may arise throughout the process
Enter coverage levels and/or prior authorization requirements for assigned accounts in database (Alfresco)
Review and correct data entry errors made by data intake team
Review and work daily pending case reports to ensure prompt processing and closure of IVRs and authorization requests
Respond to simple, routine questions from physicians, hospitals, outpatient
Determine if payer already in SalesForce database; if not, research payer on website to obtain demographic information and forward to senior team member for data entry
facilities/ambulatory care centers, etc. regarding billing, coding procedures, and processes
Follow HIPAA policies and procedures to ensure compliance
Report changes/issues in coverage/reimbursement trends to management
PROBLEM SOLVING:
Effectively identifies problems as they occur and takes appropriate steps to solve them in situations where the problem is not difficult or complex
Refers complex, unusual problems to supervisor
DECISION MAKING/SCOPE OF AUTHORITY:
Under general supervision, exercises some judgement in accordance with well-defined policies, procedures, techniques
Work typically involves regular review of output by a senior coworker or supervisor
EDUCATION/EXPERIENCE:
HS Diploma or GED
Specialized skill training; certification may be required
2-5 years of experience in area of responsibility
Basic understanding of Medicare, Commercial and Medicaid health plans a plus
#IND
Apply Now
Receive assigned insurance verification requests (IVRs) from data intake; call Health Plan to obtain benefit coverage levels and prior authorization requirements to determine payer reimbursement; submit required preauthorization/predetermination paperwork to payer
Initiate contact with Health Plan and follow-up on benefit coverage requests and prior authorizations; identify and escalate issues as they may arise throughout the process
Enter coverage levels and/or prior authorization requirements for assigned accounts in database (Alfresco)
Review and correct data entry errors made by data intake team
Review and work daily pending case reports to ensure prompt processing and closure of IVRs and authorization requests
Respond to simple, routine questions from physicians, hospitals, outpatient
Determine if payer already in SalesForce database; if not, research payer on website to obtain demographic information and forward to senior team member for data entry
facilities/ambulatory care centers, etc. regarding billing, coding procedures, and processes
Follow HIPAA policies and procedures to ensure compliance
Report changes/issues in coverage/reimbursement trends to management
PROBLEM SOLVING:
Effectively identifies problems as they occur and takes appropriate steps to solve them in situations where the problem is not difficult or complex
Refers complex, unusual problems to supervisor
DECISION MAKING/SCOPE OF AUTHORITY:
Under general supervision, exercises some judgement in accordance with well-defined policies, procedures, techniques
Work typically involves regular review of output by a senior coworker or supervisor
EDUCATION/EXPERIENCE:
HS Diploma or GED
Specialized skill training; certification may be required
2-5 years of experience in area of responsibility
Basic understanding of Medicare, Commercial and Medicaid health plans a plus
#IND
Apply Now