Insurance Verification Specialist chez InMindOut Emotional Wellness Center LLC

Description

Position: Insurance Verification Specialist 

FLSA Status: Non-Exempt  

Reports To: Director of Operations 

PRIMARY FUNCTION/PURPOSE?

The Insurance Verification Specialist plays a vital role in access to healthcare services by ensuring accurate verification and validation of insurance coverage, obtaining pre-authorizations, and entering data accurately into the EHR, thereby facilitating seamless billing and reimbursement processes. The Insurance Verification Specialist must have expertise in medical insurance policies, and excellent communication skills to handle insurance coverage inquiries and interact with patients, insurance providers, and staff. His/her ability to thrive in a fast-paced environment will contribute to the overall efficiency and success of this position.  

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES

Insurance Verification

• Verify and validate insurance coverage for patients prior to their appointments or procedures. 
• Determine patients' insurance benefits, including deductibles, co-pays, and coverage limitations, to ensure accurate billing and reimbursement. 
• Accurately record insurance details and related information into electronic health records (EHR) systems or practice management software. 
• Communicate with patients and staff to obtain necessary insurance information, update records, and address any insurance-related concerns or questions, including insurance benefits, financial responsibilities, and out-of-network status.  
• Communicate with insurance providers to obtain pre-authorization for medical services, ensuring compliance with their requirements. 

Billing

• Collaborate with the billing department to resolve any insurance-related issues and discrepancies to ensure timely reimbursement. 
• Assist in the preparation and submission of insurance claims, ensuring accurate coding and adherence to insurance guidelines. 
• Stay up to date with insurance regulations and guidelines, ensuring compliance with IMO, legal and ethical standards. 
• Handle insurance-related inquiries, resolve issues, and troubleshoot any discrepancies or denials, escalating complex cases when necessary. Collaborate with the staff and management to identify and address any potential issues and/or areas for improvement. 
• Prioritize and manage insurance verification tasks to meet deadlines and maintain efficient operations within the medical office. 
• Prepare and submit accurate documentation, data, and reports related to insurance verification activities, and compliance. 
• Other duties as assigned in support of the organization. 

GENERAL PROFESSIONAL DEVELOPMENT

• Functions effectively in response to workflow or ongoing direction by management 
• Understands and functions in a customer-first service capacity with the ability to connect and build rapport with patients/customers in person or over the phone. 
• Ability to work effectively with people of diverse cultures, ages, and economic backgrounds.? 
• Self-motivated and strong initiative  
• Strong problem-solving skills, good judgment, and attention to detail?? 
• Ability to multi-task and work cooperatively with others 
• Good attendance and punctuality 
• Knowledge of maintaining information in an EHR 
• Knowledge of insurance guidelines including HMO, PPO, and other payer requirements and systems 
• Knowledge of medical terminology likely to be encountered in insurance verification and /or claims. 
• Familiarity with CPT and ICD-10 Coding 

PROFESSIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES

• Must possess a high school diploma or General Educational Development (GED) certificate. 
• Required: 6 months of healthcare or related experience 
• Preferred: Minimum of 1 - 3 years of experience in a medical office setting, a healthcare or related field 
• Preferred: Knowledge of business processes usually obtained from a degree in Business Administration, or Health Care Administration? 

LICENSES & CERTIFICATIONS

• Required: Valid state Driver’s License 
• Preferred: Automobile insurance with reliable transportation 

TECHNICAL SKILLS

• Competent use of computer systems and basic typing skills 
• Demonstrates necessary proficiency with healthcare electronic clinical systems, including EHR and scheduling systems in medical office settings. 
• Proficient in clerical/administrative skills, including Microsoft Office suite and other general office software. 
• Proficient with typical office equipment: Computer, Copier, telephone, Fax, credit card machine, scanner 

COMMUNICATIONS SKILLS

• Effective communication abilities to interact via phone, email, and/or in person with all stakeholders. 
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable manner. 
• A calm manner and patience working with either patients or insurance companies. 
• Preferred: Bilingual skills in English and Spanish language 

IMO is an Equal Opportunity/Affirmative Action Employer.?All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.?