Full Description

Title: Insurance Verification Specialist (IVS)

Reports to: Director of Revenue Cycle Management

FLSA Status: Non-Exempt Personnel Supervised: None

POSITION SUMMARY

Under general supervision the IVS is responsible for verifying insurance benefits, obtaining pre-authorization and authorizations for all services rendered by the provider assigned to the team member. Works closely with center leaders, center staff and insurance companies to verify the patient’s individual benefits. Relies on extensive experience of the authorization process, understanding of insurance and ability to work independently in order to meet the goals of the dept.

MINIMAL QUALIFICATIONS

High school graduate or equivalent required 3-4 years’ healthcare insurance verification experience required Knowledge of medical terminology or concepts is required Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is required

RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following

Responsible for the Insurance benefits and authorization process. Submit Authorization to Insurance companies to include the use of “Cover my Meds” & “Availity” software among others. Submit additional paperwork, documentation necessary to Authorize a medication or service. Responsible for correctly identifying and updating various types of insurance entry information. Understanding of the different product websites to get discounted pharmaceuticals for a patient’s benefit. Correctly document patient charts and complete the Authorization forms to assist coders in processing claims. Work closely with the HCA and other team members in order to make the registration and benefits process seamless. The ability to speak with different insurance companies via phone to identify correct coverage, benefit details and authorization needs. Proper phone etiquette when speaking with Providers, staff and patients. Strong organizational, time management and documentation skills. Maintain Company dashboards

Knowledge of

Federal laws and regulations affecting coding requirements Electronic Health Records Knowledge of billing practices and billing office functions including FQHC environment Knowledge of medical records, E H R Must have good math skills and effective communication skills Must have good problem-solving skills

Responsibility, Skills, and Difficulty of Work

Communicating clearly and concisely, orally and in writing Confidentiality Ability to use the computer Ability to work independently to accomplish assigned work in a timely manner Ability to communicate with staff and the public, both in person and over the phone, in a tactful manner and under difficult situations Understanding and carrying out verbal and written directions Follow CFHC policies and procedures Ability to work independently