Insurance Verification Specialist

Reporting to the Director of Centralized Insurance Verification – Enterprise RCM, the Insurance Verification Support Specialist-Enterprise is responsible for verifying insurance coverages, obtaining initial Preauthorization’s and ensuring accurate data collection and entry for assigned locations. Ability to handle a heavy workload, multiple requests, interruptions, and short deadlines in a positive manner, establishing priorities for effective work completion.

Position Overview:

Reporting to the Director of Centralized Insurance Verification – Enterprise RCM, the Insurance Verification Support Specialist-Enterprise is responsible for verifying insurance coverages, obtaining initial Preauthorization’s and ensuring accurate data collection and entry for assigned locations. The IV Support Specialist will use their knowledge to help drive the streamlining of processes and delivering efficient insurance verification services.

Responsibilities:

• Maintains current knowledge of patient scheduling, registration/intake processes and systems, medical necessity review, insurance eligibility verification and authorization, and billing models.
• Performs insurance verification process and completes it with thorough documentation of benefits, patient information and patient responsibility based on insurance contracts
• Enters complete and accurate information into computer system, such as on verification button, in comments, in registration module, etc., so that mistakes are avoided, claims are clean and all information is available to all appropriate personnel
• Verifies that procedures scheduled are procedures covered when performed in an ASC by the payer
• Uses all calculators available such as Medicare, workers compensation, out of network, etc., accurately
• Calculates allowable as directed by management for all cases.
• Effective critical thinking, problem solving and decision-making skills.
• Flexible work style, tactful, poised, and patient. Ability to handle a heavy workload, multiple requests, interruptions, and short deadlines in a positive manner, establishing priorities for effective work completion.
• Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership.
• Other duties as assigned

Required Skills

Requirements:

• 2-5 years of verification, authorization or scheduling experience. Ambulatory Surgery Center experience is highly preferred
• Working knowledge of how to access benefits from various sources such as phone, person, websites
• Ability to interpret benefits in order to convey to patient and to calculate allowable/patient responsibility amounts
• Sound judgment and strong skills with respect to interpersonal relations, critical thinking, problem solving and analysis.
• The ability to communicate effectively, both verbally and in writing, with internal and external clients.
• Be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
• Ability to work independently and as a member of the team.
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Proficient in Microsoft Office including Excel and Outlook
• Advantx, gMed, HST, Waystar experience preferred.
• High School Diploma or equivalent.

Required Experience