Insurance Verification Specialist: Outpatient Treatment Centers

Job Details

Primary Duties And Responsibilities

The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services.
He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization.
Accurately and timely codes insurance in the billing system.
Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving.
Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
Accurately enters insurance benefit and authorization information into patient accounts.
Seeks assistance as needed to maintain service levels.
May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested.
Performs other duties as assigned.

Handles more complex accounts and higher volumes.
Tightly monitors day-day inventory to ensure insurance authorizations are in place before services are rendered.
Maintains productivity expectations with low error rates.
Verifies that scheduled services match with the Physician orders on file.
Interprets medical policies and Local Coverage Determination (LCD’s) to determine coverage requirements and to facilitate proper authorizations.
Works all STAT requests within 48 hours.
Serves as a Subject Matter Expert (SME) and internal resource for the team.
Participates in process improvement projects.

Education and Experience

High school diploma or equivalent required. Two to three years’ experience in patient access or related healthcare experience required.
Two years’ insurance verification experience required.
Intermediate knowledge of Windows computers and data entry required.
Experience with billing, insurance verification, coding, authorization guidelines, ICD 10 and CPT-4 coding, and/or medical terminology preferred.

Additional department specific requirements are:

Outpatient Treatment Center: Two to three years’ experience in hospital registration with strong emphasis in Oncology preferred.