The Insurance Verification (IV) Specialist is responsible for insurance and benefit verification processing for surgeries, admissions, OP Radiology, and all other services as assigned. Works directly with patients, internal and external business partners (I.e. IPAs and insurance companies), and clinical departments for delivery of services to include but is not limited to: verification of insurance benefit and coverage, explanation of clinical documentation to support proper authorization and level of service, obtaining authorizations for services, and for accuracy of benefit data to insure timely reimbursement of services. Has expert knowledge of deductibles, copayments, coinsurance, CPT and Diagnosis/Procedure Codes, Medical policies, LCD’s and Medical terminology. Works efficiently to ensure documentation and notification is processed in a timely manner. Strives within a team atmosphere, has strong customer service expertise, has ability to multi-task, and proficient computer skills.
Insurance Verification Specialist – Level I:
- Verify insurance coverage for all assigned patients. Ensure procedure is covered under the patient’s plan and guidelines.
- Accurately code insurance in the billing system to ensure timely billing. Document all copayments, co-insurance and deductible limits. Determine out-of-pocket cost and provide patient price estimates.
- Generate task reports to monitor workload and inventory. Seeks assistance when needed to maintain 100% service level targets.
- Arrange for peer-to-peer evaluations between physician offices and insurance companies as requested.
- Provide patient education of service benefits, status of pending or denied authorizations and for limited benefit coverage.
- Seeks assistance to maintain service level and to avoid delays in patient care. Avoids cancellation of service at all cost.
- Perform other duties as assigned.
Education, Training and Experience
- High School diploma or equivalent with three (2-3) years of patient access or related healthcare experience.
- Background in billing, insurance verification, coding, patient access or appointment scheduling. Degree and/or certificates in related field.
Skills or Other Qualifications
- Intermediate level knowledge of Windows computers with a solid keyboard data entry skills and working knowledge of basic office equipment.
- Ability to multitask consistently and tolerate interruptions.
- Good organizational and follow-through skills.
- Excellent communication skills, interpersonal written and verbal.
- Possesses thorough knowledge of insurance verification and authorization guidelines for hospital inpatient, surgical, and outpatient services.(including insurance requirements and guidelines, ICD-10 and CPT 4 coding).
- Knowledge and understanding of benefit plans, plan and coverage, and claims responsibility.
- Strong grasp on medical terminology.