Benefits Verification Specialist

Benefits Verification Specialist

Job Description

Job Duties:
Contacts insurance companies to verify insurance benefits; initiates pre-authorization requests for new and ongoing services with insurance companies and performs follow up activities for an outcome; files Appeals for denied coverage to insurance companies as needed

Must have prior authorization/verification experience.
Contacts insurance companies to verify insurance benefits.
Initiates Pre-authorization, PCP referral and Letter of Agreement requests for new and ongoing services with insurance companies and performs follow up activities for an outcome.
Files Appeals for denied coverage to insurance companies as needed.
Maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance company.
Coordinates and communicates with other departments as needed to obtain necessary information to complete benefit verification, authorization, appeals and outcomes for services of care.
Provides customers with information that includes but is not limited to: updates on status of authorizations, developing & communicating patient financial responsibility estimates, and collecting co-pays, if applicable.
Applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes.
Performs other related duties as assigned.

Required Qualifications
High school diploma or GED required
Preferred two or more years’ experience, but a minimum of 1 year experience is required in insurance benefits verification and/or collections and/or managed care contracting.
Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
Must be able to work under pressure and meet deadlines

Skills Utilized:
Understanding of Medicare rules and regulations;
understanding of managed care as it relates to benefits and authorizations;
advanced MS Office experience; strong verbal and written communication skills;

Notes:
Monday-Friday 8am-4:30pm EST

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.