Job Description

The Insurance Verification Specialist is responsible for clerical functions that include verification of insurance information, calculating estimated patient portions due for rendered services, and resolution of insurance problems for all patients scheduled for services. The Insurance Verification Specialist will work within the policies and processes as they are being performed across the entire organization.

QUALIFICATIONS:

• High school diploma and a minimum of 1 year of relevant experience and/or training, or equivalent combination of education and experience. Experience must include understanding payer eligibility electronic returns, and the ability to differentiate between insurance plans, copay, deductible, and coinsurance.
• Possession of strong problem solving skills and sound judgment.
• Ability to collaborate across departments and build effective relationships with internal and external customers to achieve goals.
• Knowledge of customer service principles and practices.
• Ability to achieve team goals while demonstrating organizational values and utilizing resources responsibly.
• Ability to be proactive and take initiative.
• Exhibit high level of quality through attention to detail, accuracy, and monitoring of work.
• Possession of strong organizational skills.
• Excellent verbal and written communication, as well as exceptional interpersonal communication skills.

Requirements

DUTIES AND RESPONSIBILITIES:

• Familiarization with insurance carriers that APC is contracted with.
• Place phone calls to patients, patient’s family/significant other, insurance companies, and facility personnel in an attempt to acquire information necessary to verify.
• Maintains patient demographic information and data collection systems.
• Verify insurance eligibility for upcoming appointments by utilizing online websites or by contacting the carriers directly.
• Review patient deductibles and/or copays and enter into the billing system provided for all front end staff at all locations.
• Assist front end staff and call center staff in understanding carrier websites and verification of eligibility.
• Answers questions from patients, clerical staff and insurance companies.
• Performs miscellaneous job-related duties as assigned.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations; adheres to APC policies and procedures.

WORK RELATIONSHIPS:

Direct Supervision: Director of Patient Access

WORKING CONDITIONS:

Environmental Conditions:

• Medical Office environment

Physical Conditions:

• Must be able to work as scheduled
• Must be able to sit and/or stand for prolonged period of time
• Duties involve moving materials, weighing up to 30 lbs.
• Required eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.