VERIFICATION SPECIALIST

PURPOSE OF POSITION

The primary responsibility of this position is to perform verification prior to patient visits to ensure accurate and reliable front-end patient insurance and demographic information in order to eliminate back-end denials and produce clean claims. 

RESPONSIBILITIES & EXPECTATIONS

• Demonstrates the ability to meet all critical responsibilities and expectations of the Registration/scheduler position, and provide coverage in cases of urgent need as identified by the Therapy leadership team
• Verification of all patient insurance information at least two days (three days preferred) in advance of visit for prescheduled visits, or same day for add-on visits.
  • Eligibility
  • Copayment or Coinsurance Amount
  • Policy coverage and limitations such as:  CPT code restrictions, visit limits, personnel restrictions, per day unit charge maximums
  • Verify that all information obtained during the verification is correctly entered into the appropriate electronic system (Medipac, Cerner)
    1. Document non-covered services in approved manner so that clinicians are aware
    2. Following up with patients directly if there are discrepancies prior to their appointment
    3. Cancelling appointments due to insurance issues in Cerner Schedule Book to ensure accuracy of daily schedules
• If the known insurance is no longer active, contact patient prior to visit to obtain new insurance information and start verification process again with new information.
• Obtain a prior authorization if required by patient's insurance plan once evaluation has been completed and treatment plan has been proposed by the therapist
• Contact all new patients to obtain required information that was not obtained when the appointment was made.
• Assist with creation, modification and maintenance of reference materials for staff to aid in proper identification of insurances and related authorization requirements
• Assist as directed with review of adjustments and denials
• Any other duties relating to the business operation of the practice that may be assigned by the manager.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, or veteran status.

QUALIFICATIONS

• High school graduate or equivalent, minimum of 18 years of age
• Clerical experience and Microsoft Office proficiency are preferred
• Excellent telephone and interpersonal communication skills are required
• Prefer experience in office setting or billing setting
• Knowledge of medical terminology, anatomy, physiology and disease process
• Knowledge of insurance payers
• Demonstrates the ability to utilize computer hardware, software programs, and/or the Internet (Ex. EMR, government & commercial on-line programs, access insurance carrier information, use excel or word, etc.)

WORKING CONDITIONS:

• Hours of operation with shifts as assigned including occasional overtime, on-call or off-shifts (evenings and/or weekends) scheduled as necessary.
• Lunch and break periods must be coordinated with other staff members to maintain adequate staffing during hours of operation.
• Subject to frequent interruptions and changes in priority of duties throughout the day.
• Subject to emergency and other crisis situations
• Hazardous Exposure Category 2
• Sitting/standing/moving about during working hours (see attached Physical Requirements Addendum for details)

PHYSICAL REQUIREMENTS ADDENDUM

PURPOSE:  To identify specific functions, job requirements and work environment factors that could affect job performance.

Check all factors that are present as essential job requirements and check whether the factor is performed.

O = Occasionally = 0- 33% of the work shift or   0- 32   repetitions.

F = Frequently = 34-66% of the work shift or 32-200 repetitions.            

C = Constantly = 67-100% of the work shift or 200 repetitions.

N = Not essential job requirement.

O           Standing

F            Walking

N            Lifting (70 pounds)

N            Carrying (70 pounds)

N            Pushing (70 pounds)

N            Climbing with (70 pounds)

O           Stooping/Bending

O           Twisting/Turning

O           Kneeling/Squatting

N            Crawling

F            Reaching Up/Reaching Forward

Additional information concerning physical requirements for the position:

None

HAZARDOUS EXPOSURE CATEGORY

Category II