The specialist verifies patient insurance coverage for surgeries and procedures, creates cost estimates, and ensures financial clearance by updating accurate benefit information in the Electronic Medical Records (EMR). Essential functions include resolving coverage issues, serving as a liaison between parties, and calculating patient financial responsibilities per payer contracts.
Requirements summary
Candidates must possess a High School Diploma or GED along with one year of experience in revenue cycle management and one year of insurance verification experience, preferably in a hospital or ASC setting. Required abilities include knowledge of HIPAA, proficiency with basic computer functions, and strong understanding of insurance verification processes, managed care, and medical coding.
high schoolAttention To DetailCommunicationProblem SolvingMedical TerminologyEMRMicrosoft OfficeData EntryInsurance VerificationHIPAACPT CodingBenefit VerificationManaged CarePrior AuthorizationFinancial ClearanceICD10
Job description
Revenue Cycle Management is looking for an Insurance Verification Specialist to join our team! **Hybrid/Remote opportunity after 90 days of in-person training**
SUMMARY
The Insurance Verification Specialist is responsible for verifying the patient's insurance coverage, ensuring surgery and procedures are covered by an individual’s insurance plan. Creates cost estimates prior to the surgery date and communicates cost to patients. In addition to, entering and verifying accurate data and updating patient benefit information in the Electronic Medical Records (EMR).
Essential
Functions:
Assists front office with verification questions or concerns
Resolves any coverage issues and update patient EMR
Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient EMR
Serves as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts
Verifies patient insurance coverage and benefits through online portals, phone calls, and other resources
Verifies insurance eligibility along with benefits and ensures all notifications and authorizations are completed by the surgery date
Identifies patient accounts based on self-pay, PPO, HMO, personal injury, workmen’s compensation or other managed care organizations
Collects relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders
Communicates with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained
Responds to inquiries regarding patient accounts with appropriate and accurate information in a professional manner
Ensures accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information
Creates financial arrangements, alongside management, when a patient is unable to complete payment
Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
Collaborates with billing and coding departments to ensure correct processing of claims
Benefits
Dental Insurance
Vision Insurance
Medical Insurance
401(k)
Long-term Disability Insurance
Short-term Disability Insurance
Employee Assistant Program
Accidental Death & Dismemberment Plan
Calculates co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
Completes high-quality work while adhering to productivity standards
Performs miscellaneous job-related duties as assigned
Knowledge, skills, and abilities
Demonstrates ability to use basic computer functions, technology and Microsoft office (excel, word)
Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations
Ability to work independently with little or no supervision as well as function within a team
Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization
Good communication skills (verbal / written) providing a great patient experience
Ability to work effectively in a fact paced environment
Strong knowledge of managed care, medical terminology, CPT Coding and ICD10
Demonstrates use of appropriate modifiers, HIPAA regulations, and insurance verification procedures
Knowledge of payor guidelines including reading, understanding and interpreting medical records and payor requirements etc.
Ability to think critically, assess problems and provide problem resolutions
Demonstrates attention to detail, accountability, people skills, problem solving and decision-making skills
Education and experience
High School Diploma or GED
One (1) year of revenue cycle experience
One (1) year of experience with insurance verification in a hospital/ASC setting
Benefits
3 Medical Plans
2 Dental Plans
2 Vision Plans
Employee Assistant Program
Short- and Long-Term Disability Insurance
Accidental Death & Dismemberment Plan
401(k) with a 2-year vesting
PTO + Holidays
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.
Employment for this position is contingent upon the successful completion of a background check and drug screening.
