Verification of Benefits Specialist

Description

Principle Responsibilities

• The following reflects management’s definition of essential functions for this job, but does not restrict the tasks that may be assigned.
• Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
• Contacts insurance companies to verify insurance benefits.
• Initiates Pre-authorization, PCP referral and Letter of Agreement requests for new and ongoing services with insurance companies and performs follow up activities for an outcome.
• Files Appeals for denied coverage to insurance companies as needed.
• Maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance company. 
• Coordinates and communicates with other departments as needed to obtain necessary information to complete benefit verification, authorization, appeals and outcomes for services of care.
• Provides customers with information that includes but is not limited to: updates on status of authorizations, developing & communicating patient financial responsibility estimates, and collecting co-pays, if applicable.
• Applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes.
• Performs other related duties as assigned.

Required Qualifications

• High school diploma or GED required
• Preferred two or more years’ experience, but a minimum of 1 year experience is required in insurance benefits verification and/or collections and/or managed care contracting.
• Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices
• Understand the process for verification of benefits or collections as it relates to the policies and procedures for effective placement of medical services.
• Complete Understanding of Medicare Rules and Regulations
• Understanding of Managed Care as it relates to benefits and authorizations
• Advanced MS Office experience, with an emphasis on MS Excel desired
• Continued Self Improvement courses & seminars related to position along with “In House” programs provided by Client.

Preferred Qualifications

• Associate’s Degree Preferred
• Knowledge in Medical Insurance
• Knowledge in Contracting and Fee Schedules
• Strong Computer/Software Skills

Physical Requirements

• Must be able to work at a computer workstation for extended periods of time