General Position Summary:
The Insurance Verification Specialist works as part of the administrative team and is responsible for verifying patient insurance coverage and obtaining prior authorizations for services. This role ensures accurate and timely processing to support patient access to care and proper reimbursement for services rendered.
Essential Duties and Responsibilities:
1. Verify patient insurance eligibility, benefits, and coverage prior to scheduled services.
2. Verify patient eligibility status for reduced fee if applicable.
3. Document in patient chart missing information needed.
4. Obtain and track prior authorizations for medical services and procedures.
5. Inform patients and/or Patient Assistance Specialists of insurance coverage, authorization status, and potential financial responsibility when appropriate.
6. Maintain accurate and up-to-date records in the electronic health record (EHR) and practice management system.
7. Monitor authorization requests to ensure timely approval and prevent delays in patient care.
8. Follow up on pending, denied, or incomplete authorizations and take appropriate action.
9. Assist in resolving claim denials related to eligibility or authorization issues.
10. Collaborate with billing, front desk, and clinical teams to support efficient revenue cycle operations.
11. Ensure compliance with organizational policies, payer regulations, and applicable
federal/state guidelines.
12. Stay current on payer guidelines, insurance policies, and authorization requirements.
13. Support process improvement efforts to enhance workflow efficiency and reduce authorization delays.
14. Ensure confidential information gained through job performance is kept confidential.
15. Must demonstrate good internal and external customer service skills.
16. Follows supervisor's instructions.
17. Physical attendance is an essential element of the job and necessary to perform the essential functions of the Insurance Verification Specialist.
18. Assists other department members as needed.
19. Performs other duties as assigned.
Other Functions:
1. Staff will abide by the Code of conduct as documented in the Corporate Compliance Manual.
2. Must demonstrate a personal and professional commitment to Johnson Health Center and its mission.
3. Treats all patients and staff with dignity and respect, mindful of the cultural differences of the diverse population we serve.
4. Management may modify, add or remove any job functions as necessary, or as changing organizational needs require.
JHC Core Values:
Staff members must actively demonstrate dedication and commitment to the core values of JHC.
1. Respect- We value and respect each patient, their family, ourselves, and each other. Every individual associated with Johnson Health Center will be treated with dignity and respect. We value and respect people's differences, show empathy to our patients, their families and each other, and work collectively to build Johnson Health Center as a health center and an employer of choice.
2. Integrity - We are committed to doing the right thing every time.
Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical behavior. We are accountable for the decisions we make and the outcome of those decisions.
3. Excellence - We will pursue excellence each and every day in activities that foster, teamwork, quality improvement, patient care, innovation, and efficiencies.
At Johnson Health Center, our medical, dental, pharmacy, behavioral health, front desk and administrative teams are passionately committed to the highest quality of care for our patients. We continually seek out ways to enhance the patient experience and promote an environment of continuous quality improvement.
4. Innovation- We value creativity, flexibility, and continuous improvement efforts.
We are advocates and instruments of positive change, encouraging employees to engage in responsible risk-taking and working to make a difference. Out of the box thinking enables us to build on successes and learn from failures.
5. Teamwork - We understand that teamwork is the essence of our ability to succeed.
We work across functional boundaries for the good of the organization. Our collaborative approach ensures participation, learning and respect and serves to improve the quality of patient care. By focusing on a team-based approach, the expertise of each Johnson Health Center employee is leveraged to optimize the patient experience.
Qualifications:
1. High School diploma or equivalent.
2. Previous billing experience required.
3. Must be self-motivated with well-developed organizational skills and computer experience, including, but not limited to, Word, Excel, and database functions.
4. Must possess strong communication skills; works well with external organizations and employees.
Physical Demand and Working Environment:
Fast paced office setting with travel to other offices often. Lifting and/or exerting force up to 15 pounds occasionally, with frequently moving of objects. Work requires speaking, sitting, bending, walking, standing, hearing, and stooping, kneeling, and repetitive motion with certain activities. Up to 10 hours of constant computer usage. OSHA low risk position.
Qualifications:
1. High School diploma or equivalent.
2. Previous billing experience required.
3. Must be self-motivated with well-developed organizational skills and computer experience, including, but not limited to, Word, Excel, and database functions.
4. Must possess strong communication skills; works well with external organizations and employees.
