Verification of Benefits Specialist

Verification of Benefits Specialist - Exact Billing Solutions

Lauderdale Lakes, FL (Onsite opportunity)

About Exact Billing Solutions

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.

Job Summary:

We are seeking a highly detail-oriented and organized Verification of Benefits (VOB) Specialist to join our team. In this role, you will primarily focus on verifying insurance benefits for both in-network and out-of-network services, ensuring that all patient services are processed accurately and efficiently. You will also assist in supporting the utilization review process, ensuring compliance with regulatory standards and payer requirements. This position collaborates closely with clinical teams, insurance providers, and other healthcare professionals to ensure timely, accurate, and effective patient care.

Key Responsibilities:

1. Verification of Benefits (VOB):
   • Verify patients' insurance coverage and benefits for medical services, including both in-network and out-of-network benefits.
   • Document benefit information accurately, including deductible, copay, coinsurance, maximum out-of-pocket limits, and coverage exclusions.
   • Communicate benefit details to patients, caregivers, providers, and internal teams in a clear and professional manner.
   • Identify and resolve discrepancies or inconsistencies in benefit details by liaising with insurance carriers.
   • Track and document prior authorization requirements and initiate authorizations when necessary.
   • Stay updated on changes in insurance policies and payer requirements to ensure accurate benefit verification.
   • Collaborate with the billing and collections teams to resolve claims-related issues tied to insurance verification.
2. Utilization Review Support:
   • Assist in reviewing and analyzing clinical records to ensure they meet insurance and regulatory requirements for medical necessity and service utilization.
   • Provide support for the authorization process by ensuring that necessary documentation is available and up to date.
   • Work with clinical and insurance teams to facilitate timely treatment authorizations and address any issues with claims denials.
3. Audit and Compliance:
   • Perform audits of insurance benefits and clinical records to ensure compliance with payer policies and internal standards.
   • Identify discrepancies, missing information, or areas where clinical records and benefit information need updates to meet required standards.
   • Ensure that all documentation adheres to HIPAA and company policies regarding patient confidentiality and data security.
4. Insurance Liaison:
   • Coordinate with insurance providers to obtain benefits information and resolve any issues related to benefit verification or claims denials.
   • Provide documentation and supporting materials for verification and re-verification of insurance requests, ensuring timely submissions.
   • Maintain accurate records of communications with insurance carriers, clinical teams, and other relevant stakeholders.