About this role
Insurance Verification Specialist
Accessibility Note:
Surgery Partners is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended (“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualified people or applicant with regard to any terms or conditions of employment on the basis of such individual’s disability. Consistent with this policy of non-discrimination, the Company will provide reasonable accommodations to an individual with a disability, as defined in the ADA or applicable law, who has made the Company aware of his/her disability, unless doing so would cause an undue hardship to the Company.
JOB TITLE: Insurance Verification Specialist
GENERAL SUMMARY OF DUTIES: Responsible for verifying assigned patient insurance benefits in a timely manner. Maintains optimal patient, referring physician, and insurance company satisfaction.
SUPERVISION RECEIVED: Billing Manager
ESSENTIAL FUNCTIONS:
- Ensure all records are maintained in absolute integrity and in compliance with applicable regulations and requirements.
- Obtaining required referrals and authorizations via phone, fax, on-line, etc.
- Review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification.
- Obtaining retro-authorizations or updating existing authorizations in a timely manner.
- Data entry in a fast-paced environment with high expectation on accuracy.
- Updates the patient account with details of the insurance verification.
- Coordinating with patients regarding their insurance benefits.
- Identifies deductibles, co-pays, and self-pay accounts.
- Notifying the appropriate staff members if treatment or service is denied.
- Re-verify patients monthly for active, current insurance.
- Assist manager and other staff with account questions when presented.
- Perform other duties as assigned.
- Relies on experience and judgment to plan and accomplish goals.
EDUCATION: High School, with 1-2 years experience in healthcare insurance billing and verification, collections and/or authorizations.
KNOWLEDGE:
- Knowledge of clinic policies and procedures.
- Knowledge of managed care contracts and utilization.
- Knowledge of computer systems, programs and spreadsheet applications.
- Knowledge of medical terminology.
- Knowledge of CPT/ICD-9
SKILLS
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- Skill in gathering and reporting claim information.
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- Skill in solving utilization problems.
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- Skill in written and verbal communication and customer relations.
ABILITIES:
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- Ability to work effectively with medical staff and external agencies.
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- Ability to identify, analyze and solve problems.
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PHYSICAL/MENTAL DEMANDS: Requires sitting and standing associated with a normal office environment.
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ENVIRONMENTAL/WORKING CONDITIONS: Normal busy office environment with much computer and telephone work.
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This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
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Equal Employment Opportunity & Work Force Diversity
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Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws. This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc. Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.
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Surgery Partners conducts pre-employment screenings including but not limited to criminal background checks and drug testing.