Verification Specialist

JOB SUMMARY:

This position is responsible for verifying and documenting all of the patient’s health insurance eligibility, benefits, coverage/non-coverage information and initiation/extension of authorizations.

REQUIRED EDUCATION AND EXPERIENCE:

• A high school diploma or general education degree (GED) equivalent is required; some college preferred with insurance verification experience or equivalent combination of education and experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Recognizes patients’ rights and responsibilities and supports them in the performance of job duties; respects patient’s rights to privacy and confidentiality.
• Verifies health insurance coverage and benefits for assigned payers etc., Blue Cross Blue Shield, commercial, worker’s compensation, and government/state insurance plans and determines patient’s responsibility.
• Enters insurance information into CPR+ and notifies home office of any IV or high dollar drug and of coverage and benefits.
• Determines if pre-certification or prior authorization is required from insurance company.
• Follows up on pending or expired authorizations.
• Documents, in detail, phone calls, phone number, person spoken to and call details on a consistent basis.
• Maintains a thorough understanding of NDC (National Drug Code) numbers, billing units, metric quantities and etc.
• Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations and medical codes.
• Shares knowledge gained with other staff members and works as a team member.
• Interacts with others in a positive, respectful, and considerate manner.
• Performs other job related duties as assigned.

QUALIFICATION REQUIREMENTS:

• Knowledge of insurance verification.
• Ability to communicate effectively and professionally with patients, visitors, physicians, and coworkers.
• Ability to make decisions, solve problems, and work independently with little supervision.
• Demonstrate extreme attention to detail and accuracy.
• Ability to prioritize and meet deadlines.
• Basic computer proficiency.
• Knowledge in the use of Microsoft applications.