As the Verification of Benefits Specialist, you’ll have the chance to assist our patients in having accurate insurance information on file and collecting authorizations or PCP referrals as needed.

Principle Responsibilities

The following reflects management’s definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

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 companies.
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.

Must have prior authorization/verification experience.

Required Qualifications
High school diploma or GED required
Preferred two or more years’ experience, but a minimum of 1 years’ 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, while maintaining a positive attitude and providing exemplary customer service
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices
Understand the process for verification of benefits or collections as it relates to the policies and procedures for effective placement of medical services.
Complete Understanding of Medicare Rules and Regulations
Understanding of Managed Care as it relates to benefits and authorizations
Advanced MS Office experience, with an emphasis on MS Excel desired
Continued Self Improvement courses & seminars related to position along with “In House” programs provided by the client.
Must be able to work under pressure and meet deadlines

Preferred Qualifications
Associate’s degree Preferred
Knowledge in Medical Insurance
Knowledge in Contracting and Fee Schedules
Strong Computer/Software Skills

Physical Requirements
Must be able to work at a computer workstation for extended periods of time

Notes:
100% onsite.
Days/Hours: Mon – Friday 8:00am to 5:00pm