Insurance Verification Specialist

Description

Summary of Position:

The insurance verification specialist's role is to check the status of a patient’s medical insurance. The primary responsibility is to ensure that a patient’s insurance will cover medical costs.

Essential Duties:

Duties include, but are not limited to:

• Verifies patient insurance eligibility and benefits using any of the automated systems, web-based utilities, automated voice verification lines, and calling on the telephone.
• Closely coordinates with other departments, including Central Business Office (CBO), Front Office Reception, Medical, Outreach, Training Department, and Management, to facilitate the financial clearance process and service payment.
• Inform families of the availability of publicly financed healthcare programs and insurance. 
• Coordinates with staff to assist clients with establishing or recertifying for AHCCCS, a Qualified Marketplace plan, or Sliding Fee Schedule coverage.
• Performs eligibility screening and ensures proper documentation is placed in the patient’s Electronic Medical Record (EMR).
• Updates, edits, and confirms accurate financial account information on each patient visit.
• Ensures the capture of all necessary information needed for prompt and accurate payment of services provided, including scanned copies of insurance cards, Patient profiles, and Authorizations for Treatment and Patient IDs.
• Ensures and promotes 100 percent accuracy levels in the capture of all demographic and billing information for each service provided.
• Attends regular, ongoing training and development to identify insurance changes and opportunities within the insurance verification process.
• Works within the EMR system to document the results of all patient insurance verification.
• Understand the difference between Primary, Secondary, and Tertiary insurance and when and how to validate it for each patient receiving care services from Circle the City.
• Watches for changes and trends regarding insurance verification that may hamper the prompt submission or collection of submitted claims for patient services.
• Reports any identified problems to assigned manager to ensure immediate reviews are conducted and changes made where required.
• In-service and education participation regarding Quality Improvement or required job-focused education.
• Uses appropriate incident reporting procedures when documenting unsafe or problematic incidents involving patients, clients, and/or staff.
• Completes Incident Reports accurately and follows procedures completely.
• May be required to make or assist with daily patient appointment call reminders for future appointments.
• Performs all other related duties as assigned.

Qualifications

Qualifications:

Knowledge, Skills, and Abilities:

• Ability to work in a culturally diverse environment.
• Ability to provide excellent customer service.
• Ability to work under stressful situations.
• Ability to multi-task.
• Computer literate.
• Detail-oriented and open to learning new skills.
• Excellent telephone etiquette and communication skills.
• Ability to accept and make calls at a workstation.

Education and Experience

• High School Diploma or equivalent required.
• Associate degree preferred.
• Spanish speaking preferred.
• One (1) year of experience working in a medical office with relevant experience required
• Knowledge of health insurance companies, benefits, policies, and automated verification processes required.

Physical and Mental Requirements:

• Sitting for prolonged periods
• Ability to focus on a computer for long periods
• Clear and effective verbal communication with insurance
• Ability to focus on a computer screen for long periods
• Fast-Paced Environment
• Problem-Solving Skills
• Multitasking
• Time Management