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The Insurance Verification Specialist provides detailed and timely communication to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home for approximately 4-6 weeks. If you are located within commutable distance from the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral
Initiate contact with payers to complete insurance verification activities to prevent delays in care due to missing authorizations
Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered
Navigate EMR, insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization
Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care
Update health record with accurate information regarding insurance coverage based on information gathered during verification &/or authorization process
Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, departments & modalities across the continuum
Identify/escalate barriers to obtaining authorization to the insurance company or per department protocol
Respond to insurance company inquiries for information including consent forms, pre-authorization forms, 2nd opinion forms & referral forms
Coordinate with providers, payers, departments, & patients regarding authorization status and options & document outcomes in the EMR
Confirm payment coverage including the initiation of insurance & managed care authorizations
Communicate with providers & clinical delegates to resolve any outstanding information regarding pre-authorization & referral requirements
Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits assigned
Complete assigned tasks in EMR work queues & bring work lists to completion
Generate forms to insurance companies: consent, pre-authorization, second opinion and referral
Notify provider of denied procedure/request for peer-to-peer discussion with insurance company & adjust authorization status accordingly
Work independently & as part of a team in conjunction with Utilization Review/other departments as necessary to provide appropriate clinical information from the EMR to appeal the denials from the insurance company
Follow-up discharge status of patients & relay information to insurance carriers as they require
Actively participate in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriately
Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization
Requirements
High School Diploma/GED (or higher)
1+ years of experience in medical billing, medical insurance verification, managed care and/or patient registration
1+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers
1+ years of experience working with an EMR system
Intermediate level of proficiency with Microsoft Office products
Ability to work 20 hours per week, from 8:00am - 4:30pm CST Mondays and Fridays and 8:00am-12:00pm Wednesdays
Must be 18 years of age or older
Nice-to-haves
1+ years of experience in an acute care billing/insurance verification/managed care/registration department
Previous experience with prior authorizations and referrals
Previous experience with Epic medical record and medical terminology
