Insurance Verifier

The Insurance Verifier Work closely with the billing supervisor while performing all components in the Insurance Verification / Authorization process for existing and new patients as well as working closely with staff. Supports the vision and mission of Anne Arundel Gastroenterology Associates through providing excellent customer service.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Conducts insurance verification and authorization validation on scheduled patients to ensure eligibility and that benefits are in order for accurate claim submission and payment.

• Utilizes online eligibility verification system and/or may have to contact the Payer directly via telephone and/or access payer website.
• Requests pre-authorization/pre-certification for scheduled procedures, urgent procedures and imaging.
• Accurately notates the account with actions taken for pre-authorization/pre-certification.
• Receives and schedules incoming referral appointments as per policy.
• Follows up on pending authorization requests in a timely manner.
• Communicates with patient regarding patient’s financial responsibility to ensure collections of out of pocket payments (i.e, copayments, deductibles, self-pay) for procedures, as per policy.
• Answers non-medical questions and gives routine non-medical instructions.
• Must have working experience with all payer types: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross over into different payers.
• Acts as the connection between internal and external customers to assist in the account billing resolution process and to escalate issues which adversely impact claim submission and payment, as directed by supervisor.
• Ability to perform independent research prior to seeking management assistance.
• Follows department policies and procedures as required to meet payer and regulatory requirements, including procedures related to release of information, record retention, privacy and confidentiality.
• Meets and/or exceeds the daily production goal as defined by the Manager.
• Assists management team in providing training, assistance and/or guidance to other staff members in issues of accounts resolution through billing, collection and/or denial processing techniques.                                                                                                                                     
• Provides information to Manager in identifying possible areas of concern that impact account billing or collections accurately and in a timely manner. 
• This role excludes performing any clinical tasks related to patient, including assessing or evaluating patient’s medical condition or providing clinical advice, medical care or recommendations.

• High School diploma or equivalent required. 
• 1 year in Healthcare Customer Service, Insurance Verification and Billing Systems from a Technical and Functional view (preferred)Word, Excel and Outlook experience required. 
• Ability to learn new programs and systems required.
• Ability to read and evaluate Healthcare Receivables Information (required).
• Ability to effectively and correctly communicate to the staff, management and payers.