We are looking for a Procedure Verification Specialist to join our team working a hybrid schedule in our Troy office as well as remotely. The Procedure Verification Specialist is responsible for working with the procedure scheduling team, the clinical staff, patients, and third-party payors to ensure ordered surgical and other procedures have met the documentation and clinical requirements and have been approved by the patient's insurer. The Procedure Verification Specialist verifies insurance and prior authorization for all patients prior to the date of their procedure.

Job Duties:

• Obtain prior authorization and verification of eligibility from insurance carrier for surgeries, procedures, and MRI.
• Investigate and interprets all incoming insurance information regarding patient benefits or processing changes and communicates these to appropriate personnel following department protocol.
• Verify Auto and WC insurance with the insurance carrier and verify legal representation with the attorney's firm.
• Obtain co-pay and deductible information and accurately records this information into the EHR and practice management system.
• After obtaining verification of benefits, inform patient of high deductibles and/or prepayment for upcoming surgery or procedure, to be collected prior to or on day of service
• Effectively utilize automated tools. (Web Denis, C Snap)
• Coordinates insurance referral process with patient following department needs
• Performs referral check and makes the appropriate notes in practice management system.
• Handles phone inquiries from patients, payors, medical office, and or testing facility regarding authorization, benefits, or verification.
• Other duties as necessary and/or assigned.

MINIMUM QUALIFICATIONS

• High School Diploma or GED
• Minimum 2 years medical billing office experience or equivalent experience with medical payors

Specific Knowledge, Skills, Abilities:

• Extreme accuracy in data analysis and reproduction
• Good communication and interpersonal skills
• Keyboard skills
• Medical terminology
• Knowledge of third-party billing rules
• Experience working with third-party payors

Working Conditions:

• Works in a normal busy office environment.

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance
• Wellness program

Weekly day range:

• Monday to Friday
• No weekends

Education:

• High school or equivalent (Preferred)

Experience:

• Medical Insurance Navigation: 1 year (Required)

Ability to Relocate:

• Troy, MI 48083: Relocate before starting work (Required)

Work Location: In person