Insurance Verification Services Specialist

Job Title:                           Insurance Verification Services Specialist

Location:                           Remote

Department:                    Revenue Cycle Management

Reports To:                        Insurance Verification Services Manager

Employment Type:          Hourly, Non-Exempt

Travel Required:              Yes, less than 5%

Hourly Range:                   $20-$24

Summary

Candidate performs accurate eligibility and benefit verifications for various third-party commercial insurances, Medicare and/or Medicaid.  Candidate is required to call the insurance carrier for proper benefit information for certain procedures and/or visit types determined by their Associate Director and current policies and procedures. Responsible for documenting benefit verifications within the applicable Electronic Medical Record (EMR) system.  Knowledge of insurance terminology and strong math skills are required. Must understand co-pays, deductibles, out-of-pocket and benefit maximum concepts.  Candidate must have a strong attention to detail.  Applicant must be able to multitask.  Responsibilities include report generation within applicable EMR system, contacting patients with benefit and/or eligibility information, concise documentation of benefits for affiliate staff and other various duties as assigned. Knowledge of NextGen and/or Epic EMR systems preferred but not required.

Essential Functions

• Comply with all agency protocols, policies, and procedures, including any state and federal laws and regulations. 
• This position requires long periods of time on the phone with insurance carriers, patients, internal staff and affiliate staff.
• Maintain a positive attitude and excellent customer services skills.
• Secures sufficient coverage information to confirm with insurer dates of eligibility and outline of benefits and assists with patient requests regarding benefit determinations.
• Communicates with patients and associates in a professional manner. Must have strong customer service skills.
• Update EMR system with appropriate benefit information as well as completing patient demographic changes accurately and efficiently.
• Generate eligibility reports and other various reporting needs as suited for the position.
• Ability to prioritize work through various EMR tasking or work queue methods.
• Organize and communicate benefit/eligibility information effectively with attention to detail.
• Submits status updates and feedback on processes and results to their supervisor.
• Ability to work as a team member as well as independently with little or no supervision.
• Must be able to multi-task and work in stressful situations. Able to prioritize workload.

Supervisory Responsibility: This position has no supervisory responsibility

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Customer Service and Interpersonal Skills, Oral and Written Communications
• Ethics, Diversity, Initiative, Teamwork
• Computer and Technical Skills
• Proficiency in basic mathematical calculations
• Quality, Safety & Security

Education and/or Experience

• High school diploma or G.E.D. Minimum 2 years of customer service experience.

Skills

Required

• Strong spoken and written communication skills. 
• Ability to read and interpret documents such as schedule of benefits, policies and procedures, and training manuals.
• Ability to write routine reports and correspondence. 
• Ability to speak effectively before groups of customers or employees of the organization.
• Ability to work with basic mathematical concepts
• Possess excellent understanding of insurance co-pays, deductibles, out of pocket maximums and benefit information.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to operate a 10-key calculator

Skills

Preferred

• Call center experience
• Health insurance industry experience
• Epic system experience 

Physical and Environmental Demands

The physical demands described here 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. While performing the duties of this job, the employee is regularly required to sit, talk, and listen. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.

Sedentary Work

• Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time)
• And/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Must be able to travel throughout and between facilities.
• Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
• There is no occupational risk for exposure to communicable diseases.

Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, either verbally or in writing.