Insurance Verification

Job Summary: Obtains patient eligibility information and verifies insurance coverage for new and existing patients. Will coordinate with other staff to ensure timely processing of verifications. Will verify deductibles and co-pays when necessary. Will process a high volume of new patient referrals and existing patient authorizations daily.

Working Conditions: Works in a fast-paced, well-lit, comfort controlled medical office. Work may be stressful. Interaction with others may be constant and interruptive. Occasional irregular hours. Frequent exposure to communicable disease, toxic substances, medical preparations, and other conditions common to a clinic environment.

Physical Demands: Requires sitting, data entry, and viewing computer screens for long periods of time; also stooping, bending, and stretching. Occasional lifting. Requires understanding of payer requirements, electronic verification thru the Practice Management System, operate a key board, calculator, telephone, copier, fax, and other office equipment as necessary. Vision should be correctable and hearing within a range discernible to telephone/paging contacts.

Performance Requirements: Knowledge of business office procedures. Possess good written and verbal communication skills. Ability to speak to patients and answer the telephone in a professional manner. Must read, understand, and follow oral and written instructions. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to establish and maintain effective working relationships with physicians, patients, employees, and public. Always presents a professional image. Ability to do detailed and accurate work. Utilize time management skills. Recognize, evaluate, solve problems, and correct errors. Maintain productivity and work independently. Will require demonstrated proficiency in Microsoft Office products and ability to use electronic medical records system. Will work on headset and computer for multiple hours at a time. Must have demonstrated ability to interact with diverse groups of people and to quickly change priorities as needed.

Essential Functions:

• Responsible for the pre-verification of insurance for patients prior to visit for all providers and work-in appointments per policy.
• Works with administrative staff to ensure that all patient insurance information is entered correctly.
• Ensures insurance coverage via the Mod Med Practice Management system, payer websites or phone conversations with the payer to resolve any issues with coverage and escalates any issues to a supervisor.
• Follows up on all Mod Med insurance alerts to ensure payers are identified correctly.
• Obtain authorizations from PCP if needed and enter authorizations in patient’s account, verify Insurance Surgical Benefits and obtain pre-certification for patients having surgery.
• Will call patients for insurance information when we are unable to obtain at the time the appointment is made
• Conduct pre-procedure calls to patients to inform them of deductibles or high account balances or any other monies owed.
• Accurately document all amounts owed for collection at patient check-in.

Additional Comments: This full time position requires someone who can lift 25 lbs or more and can have the flexibility to arrive at 8:00AM to open and/or be the closer in the evenings after the last patient leaves.