What are the responsibilities and job description for the Insurance Verification Specialist position at USPI?
United Surgical Partners International is hiring a full-time Insurance Verification Specialist at Quad City Gastroenterology locaated in Moline, IL.
About the Opportunity
Work closely with the Revenue Cycle Manager while performing all components of the Insurance Verification and Authorization process for both existing and new patients. Collaborate with staff to ensure smooth operations while delivering excellent customer service.
Essential Duties and Responsibilities
- Utilize the current system to conduct insurance verification and validate authorizations for scheduled patients, ensuring eligibility and benefits are in order for accurate claim submission and payment.
- Use the SSI online eligibility verification system, or contact the payer directly via telephone or website.
- Request pre-authorizations for scheduled procedures, urgent procedures, and imaging.
- Accurately document account actions related to pre-certification.
- Coordinate Peer-to-Peer reviews with providers for denied requests.
- Follow up on pending authorization requests in a timely manner.
- Communicate with the Patient Financial Advocate regarding patients' financial responsibility, ensuring the Front Office can collect payments like copays. Answer non-medical questions and provide routine non-medical instructions.
- Have working knowledge of various payer types: commercial, governmental, Medicare, Medicaid, HMOs, etc., and adapt to different payer requirements.
- Review confirmation reports to identify payer rejection issues and implement procedures to reduce future rejections.
- Act as the connection between internal and external customers to assist in billing resolution and escalate issues that impact claim submission and payment.
- Conduct independent research before seeking management assistance.
- Identify billing or payer edit opportunities.
- Follow department policies and procedures to meet payer and regulatory requirements, including record retention, privacy, and confidentiality.
- Meet or exceed daily production goals as defined by the manager.
- Assist management by training, guiding, and supporting other team members in resolving account issues through billing, collection, and denial processing techniques.
- Provide feedback to the manager on areas of concern impacting billing or collections accurately and promptly.
- Exclude clinical tasks related to patient care, such as assessing medical conditions or providing medical advice or recommendations.
Required Skills:
- Effective and accurate communication with staff, management, and payers.
Required Experience:
- High school diploma or equivalent.
- 1 year in healthcare customer service, insurance verification, and billing systems (preferred).
- Familiarity with Word, Excel, and Outlook is required.
- Ability to learn new programs and systems.
- Ability to read and evaluate healthcare receivables information
