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Insurance Verification

Summary

Responsible for verifying patient medical insurance eligibility through phone & online access of private insurance companies, Medicare, and Medicaid.

Essential Duties and Responsibilities

  • Determines insurance benefit compatibility for ASC surgery and pain management.
  • Coordinates with patients regarding their insurance benefits and procedures, re-verifying existing patient insurance coverage, and determining if an insurance benefit plan considers selected products appropriate based on patient need.
  • Obtains pre-certification or authorization for procedures and enters into billing system software.
  • Completes data entry and or appropriate forms to document patient's benefits coverage.
  • Alerts the Front Desk staff / PAC/PAR about uninsured or underinsured patients.
  • Supports leadership with daily, weekly monthly reporting needs as required 
  • All other duties as assigned

Education and/or Experience

High school diploma or general education degree (GED).  Minimum three years in medical office setting. Prior experience using electronic scheduling and electronic medical software is a plus.

Knowledge of ICD-9, CPT, HCPCS and the use of modifiers preferred. Knowledge of physician billing and/or collections. Typing speed 55 wpm and the ability to use a calculator.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should be proficient in MS Word, Excel, and PowerPoint. General knowledge of technology is preferred.

 

Physical 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; use hands to handle or feel; reach with hands and arms; and to talk or hear.  The employee is occasionally required to stand, walk; and stoop, kneel, crouch, or crawl. These duties could require the ability to lift files, open file cabinets and bend or stand as necessary. The employee must occasionally lift and/or move up to 30 pounds.  The employee will operate a keyboard, calculator, telephone, copy machine, computer and other office equipment as necessary. Specific vision abilities required by this job include close vision.

It is necessary to view and type on computer screens for long periods of time and to work in an environment which can be very stressful.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate. Must be able to deal with aggressive, hostile and sometimes irrational behavior of patients and family members and have the ability to respond to all patients in a calm and professional manner.

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