Insurance Verification Specialist/Intake Coordinator
Insurance Verification Specialist/Intake Coordinator
SUMMARY: This position is responsible for:
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Verify insurance benefits to determined cost share amounts for patients.
Enter pertinent client & staff information in a timely manner while paying special attention to detail including: initial contact information & account creation and maintenance of day to day software management
Offer recommendations to management for improvements in operational efficiencies
Comply with federal regulations, including HIPAA provisions
Examine pertinent information to determine the accuracy of client requests and related paperwork
Monitor, process, and manage scheduling email & communications to ensure accuracy of billing and payroll
Support and comply with all company policies, processes and procedures including the Compliance Program and the Code of Conduct
Review and resolve discrepancies in received data and performed data verification routines in accordance with company procedures
Assist in scanning and re-scanning overlooked requisitions
Ensure that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system.
Contact patients and pre-registering outpatients as assigned.
Ensures medical necessity is completed prior to testing.
Inform patients of their financial responsibility for services to be rendered when applicable
Initiate the pre-authorizations/pre-determinations for insurance to get verified and processed correctly
Follow up with decisions from providers
Communicate with both patients and primary care physicians (PCP's) and/or specialists in regard to standing
Communicate with patients about their estimated out of pocket payments
Follow up with doctor’s office with authorizations
Fax and email LOMN (letter of medical necessity) with clinical notes to provider for authorizations
Effectively research and resolve prescription processing rejections to ensure patients receive medications within established patient standards.
Answer and respond to calls regarding insurance related issues in courteous, professional manner.
Ability to multi-task and resolve issues independently, as well as assist others with issues.
Training new employees in the department.
Work closely with the Authorization & Billing department and staff in verifying and establishing authorization for services
Initial Authorization form completion (assist business office team as necessary)Use criteria based off client intake to determine the timing for start of services (using client service availability & location based off of service maps)
Communicates with families, clinical staff, senior staff, practitioner’s offices, clinical outreach and other stakeholders to keep them informed about clients in the intake process- Expectation: to be updated at the end of each business day until handoff to clinical team is complete & verified
Offer recommendations to management for improvements in operational efficiencies
Comply with federal regulations, including HIPAA provisions
Support and comply with all company policies, processes and procedures including the Compliance Program and the Code of Conduct
Review and resolve discrepancies in received data and performed data verification routines in accordance with company procedures
Ensure that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system.
Contact patients and pre-registering outpatients as assigned
Ensures medical necessity is completed prior to testing
Inform patients of their financial responsibility for services to be rendered when applicable
Initiate the pre-authorizations/pre-determinations for insurance to get verified and processed correctly
Follow up with decisions from providers
Ability to multi-task and resolve issues independently, as well as assist others with issues
Training new employees in the department.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.
3+ years of insurance exp. or related field or equivalent combination of education preferred
Proficient knowledge of Microsoft Office
Excellent interpersonal and relationship building skills
Great organizational and communication skills,
Solution-focused; must be great and problem-solving
Technical skills for video interviewing through zoom, web ex, etc.
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PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required to sit, stand and walk regularly, occasionally lift and/or move up to 10 pounds.
The noise level in the work environment is usually moderate. ,
Employee Signature:
Date:
PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required to sit, stand and walk regularly, occasionally lift and/or move up to 10 pounds.
The noise level in the work environment is usually moderate. ,
Employee Signature:
Date: