Insurance Verification Specialist

Top reasons to work for SMA Healthcare:

• Career growth and advancement potential
• Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance
• Tuition Reimbursement
• Paid Personal Leave (up to 25 days after 3 years of service)
• 403b Retirement Plan (matches one to one of employee contribution for the first 3%, then a 50% match on the next 6% of employee contribution)

Essential Job Functions: 

• Collect demographic and insurance data, verify insurance eligibility and benefits via computer portal systems and via telephone for commercial insurance providers, and enter financial eligibility and authorization data in SMA's EMR system.
• Run client face sheets daily for various SMA Healthcare Outpatient programs and sites as assigned.
• Notify SMA staff of insurance authorizations and insurance company expectations through email and/or phone calls.
• Notify SMA staff of co-pay/co-insurance/deductible information for the purposes of collection of client financial responsibility.
• Acts as liaison between SMA staff and insurance companies, funding sources, or their managed care organizations when client's health care is being managed under a managed care plan.
• Reviews Managed Care Report for services needing continued authorization and processes completed requests to managed care company to obtain continued authorization.
• Update authorization spreadsheet and update EMR authorization determination record to include:  services authorized, units or visits, effective and end date, provider when applicable and the authorization number.
• Review Financial Assessments when required by program, and approve and add payer if client meets eligibility requirements.
• If required by specific program, review Specialty Reports and DCF Program Client Lists, update client Credible record to reflect payer changes, keep each assigned DCF Program binder current and complete a client insurance report for each assigned DCF Program.
• Additional duties may be required as per specific program guidelines.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and/or Experience: High school Diploma and one year of Insurance Verification and/or behavioral health experience.  Experience in a setting where it was necessary to communicate orally and in writing to inform, advise, or train others about treatment service delivery, client record documentation, or Insurance Verification preferred. Experience with American Society of Addictions Medicine Patient Placement Criteria is preferred. Experience with CARF, Medicaid, and Managed Care requirements is preferred.

Knowledge/Skills/and Abilities: 

• Demonstrates proficiency with assigned client populations in performing Insurance Verification including extensive telephonic communication skills with insurance providers.
• Ability to maintain professional working relationships with insurance representatives, clinical staff, and stakeholders.
• Experience with Electronic Medical Records (EMR).

Necessary Special Requirements: Possession of a valid Florida driver's license, acceptable driving record, and proof of personal automobile insurance if required to drive an SMA vehicle and/or use a personal vehicle for SMA business. Complete State of Florida mandatory background screening prior to start of employment.  Complete SMA required training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8-12 hour day. Able to lift minimum 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence and presentation, either manually or orally. Work endurance ability to work 8-12 hour shifts with a meal break, as possible. Routine 8-12 hour shifts. Hours and days off may vary. Extra hours may be required. Work assignment locations may vary.

Application:This class specification is intended to identify the class and illustrate the kinds of duties that may be assigned to its incumbents.  It should not be interpreted as describing all of the duties whose performance may ever be required of such an employee or be used to limit the nature and extent of assignments such individuals may be given.