Insurance Verification Specialist
ESSENTIAL DUTIES AND RESPONSIBILITIES: Receive assigned insurance verification requests (IVRs) from data intake; call Health Plan to obtain benefit coverage levels and prior authorization requirements to determine payer reimbursement; submit required preauthorization/predetermination paperwork to payer Initiate contact with Health Plan and follow-up on benefit coverage requests and prior authorizations; identify and escalate issues as they may arise throughout the process Enter coverage levels and/or prior authorization requirements for assigned accounts in database (Alfresco) Review and correct data entry errors made by data intake team Review and work daily pending case reports to ensure reputed company processing and closure of IVRs and authorization requests Respond to simple, routine questions from physicians, hospitals, outpatient Determine if payer already in reputed company database; if not, research payer on website to obtain demographic information and reputed company to senior team member for data entry facilities/ambulatory care centers, etc. regarding billing, coding procedures, and processes Follow HIPAA policies and procedures to ensure compliance Report changes/issues in coverage/reimbursement trends to management PROBLEM SOLVING: Effectively identifies problems as they occur and takes appropriate steps to solve them in situations where the problem is not difficult or reputed company Refers reputed company, unusual problems to supervisor DECISION MAKING/SCOPE OF AUTHORITY: Under general supervision, exercises some judgement in accordance with well-defined policies, procedures, techniques Work typically involves regular review of output by a senior coworker or supervisor EDUCATION/EXPERIENCE: HS Diploma or GED Specialized reputed company training; certification may be required 2-5 years of experience in area of responsibility Basic understanding of Medicare, reputed company and reputed company health plans a plus #IND Apply Job!