Verification Specialist

Summary

Objective: The Verification Specialist accurately verifies demographic and insurance information for emergency and non-emergency transports.

Essential Duties:
▪ Know and support the Mission Statement, Policy/Procedures and standards of MMR.
▪ Proficient with billing and prebilling the following insurances: Medicare, Medicaid, BCBS, and Commercial including auto hospice etc.
▪ Verify coverage through C-Snap, Web Denis, and Trizetto, and verify MMR membership.
▪ Utilize hospital websites to obtain insurance information.
▪ Verify coverage and auto insurance for claim/billing information over the phone, as necessary.
▪ Obtain authorization number and record the authorization number in the required field under Tab 3numbers, prior to prebilling the claim.
▪ Contact patient for insurance information when correct information is not initially provided.
▪ Review Physician’s Certification Statement (PCS) for proper signature, medical necessity, and completeness.
▪ Obtains repetitive Physician Certification Statement (PCS) when needed 7 days prior to the expiration of a current PCS.
▪ Proficiently verify all insurances that relate to the claim.
▪ Verify and correct patient demographic information.
▪ Add CMS signature when obtained.
▪ Add signature information to Tab 3 to “Override Customer’s Signature area.
▪ Add both treating and referring physician under Tab 2 for non-emergency transports.
▪ Open and close calls.
▪ Maintains HIPAA compliance.
▪ Membership entry.
▪ Taxi billing.
▪ Pre-bill all emergency and non-emergency claims.
▪ Perform other duties as assigned.

Knowledge, Skill and Competency Requirements:

Knowledge, Skill and Competency Requirements:
▪ Medical office experience and familiarity with insurance billing practices preferred
▪ Obtain Emergency Medical Dispatcher (EMD) certification within first 6 months of employment
▪ Must proficiently use insurance websites i.e., C-Snap, Champs, Web Denis, etc., 2 months after date of hire
▪ Reading skills to comprehend correspondence and materials specific to the healthcare industry
▪ Must demonstrate ability to maintain security and confidentiality with utmost discretion
▪ Ability to communicate effectively both verbally and in writing, in the English language
▪ Ability to organize tasks and insure timely completion of all projects
▪ Advanced computer skills including the ability to utilize a computer PC with Windows operating system
▪ Ability to operate office equipment, including but not limited to, copier, fax machine, scanner, monitor, multi-line telephone, printer, typewriter and calculator
▪ Proficiency with Microsoft Word and Excel
▪ Regular attendance and timeliness
▪ Skilled in typing, data entry, scanning, electronic filing and document retrieval
▪ High School Diploma
▪ Must be at least 18 years old

Physical Factors: Suitable dexterity to operate standard office equipment. Capability to stand or sit for extended periods of time.

Working Conditions: Most work is done in a typical office setting with daily exposure in all other department areas. Regular, in-person attendance is an essential function of the job. Materials and equipment used include desktop computer, telephone, fax, copier, printer and other standard office equipment. Hours must be flexible to meet the demands of the office.