Insurance Verification Specialist

Overview

At Legacy, everything we do seeks to fulfill a common mission of making life better for others. How can you be part of that mission? By being the go-to person when insurance must be verified and liability issues must be explained. Your sense of accuracy and attention to detail will strengthen the patient-physician relationship, as they rely on you for the insurance information necessary to deliver expert care.

Responsibilities

Verifies insurance coverage and secures authorization.

Contacts insurance companies and / or medical review departments by phone, Internet, fax (face sheets), electronic interface and provides minimal necessary patient information.

Verifies coverage eligibility and obtains benefit information, deductible, co-pays if applicable, co-insurance, out-of-pocket maximums and accumulators, authorization requirements, referral requirements, days approved if inpatient, correct billing address.

Initiates and validates authorization, notification and ensures authorizations, pre-certifications and referrals are secured, when appropriate, and follows up on all pending authorizations until account is secured.

Notes any specific limitations, authorizations, exclusions, pre-existing clauses, and / or waiting periods which may apply. If any of these become an issue for patient eligibility, works with physician and / or financial counselors to discuss timing of treatment and / or payment arrangements.

Reviews detailed clinical information of trauma admissions (motor vehicle accident, personal injury, and / or worker’s compensation) to determine accident related liability.

Follows same verification procedure for each payor, since most payors require the authorization / pre-certification process even as second or third insurance coverage on a patient.

Calculate Hospital Cost Estimates based on plan benefit accumulators and CPT code(s) for hospital services. Identifies any cost discrepancies based on coding and / or Payor contract. Works with Analyst and vendors to resolve issues.

Re-verifies eligibility and ensure authorization of days extended for large dollar in-house accounts.

Provides customer service regarding insurance information.

Provides education and customer service to providers and departments regarding authorization protocols and plan benefits.

Communicates daily with Physicians’ offices, patients, Surgery Scheduling, Customer Service, Financial Counselors, Clinical Resource Counselor / Utilization Review, Managed Care offices, Managed Care onsite RNs, Insurance Companies, LH System Office of Managed Care Contracts and various other hospital departments such as Patient Access, Imaging and Rehab.

Faxes daily admission and discharge reports to designated insurance companies.

Refers non-insured or underinsured patients to the Financial Counselor to determine patient liability, Medicaid eligibility or financial assistance.

Provides documentation according to established guidelines and practice standards.

Accurately records data needed for proper billing and follow-up in appropriate system fields.

Maintains and continually upgrades knowledge and skills to ensure efficient and effective operation of team.

Maintains knowledge of contracts, managed care plans, Medicare Advantage plans, Payor / Plan codes, insurance laws, insurance company changes and shares information.

Maintains current knowledge of System policies and procedures, System updates and / or upgrades and health care information.

Attends staff meetings and training classes as required.

Qualifications

Education :

Associate’s degree in business or healthcare, or equivalent experience, required.

Experience :

Two years of directly applicable healthcare business office experience (billing / credit / collection) or applicable insurance customer service experience required. Demonstrated knowledge of insurance guidelines, including benefits and authorization protocols. Hospital insurance verification experience preferred.

Skills :

Strong written and verbal communication and demonstrated effective interpersonal skills which promote cooperation and teamwork.

Ability to problem solve in a timely, professional manner.

Demonstrated knowledge of Payor / Plan structures, Payor contracts and Payor laws.

Knowledge of CPT and Diagnosis coding and medical terminology.

Net Typing of 40 wpm and PC based computer skills.

10 key proficiency.

Knowledge of online eligibility systems and status review of claims.

Works efficiently with minimal supervision, exercising independent judgment within stated guidelines.

Ability to withstand varying job pressures, organize / prioritize related job tasks, and excellent attention to detail.

Excellent public relations skills and demonstrated ability to communicate in calm, businesslike manner.

Ability to multitask, learn new skills and adapt to change.

Ability to work in a fast-paced environment independently or as part of a team.

LEGACY’S VALUES IN ACTION

Follow guidelines set forth in Legacy’s Values in Action

Equal Opportunity Employer / Vet / Disabled

Pay Range

USD $20.83 - USD $29.79 / Hr.

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