JOB SUMMARY

• The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client’s commercial insurance coverage and to ensure procedures are covered by an individual’s insurance.
• Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization’s billing system and verifying that existing information is accurate.
• The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions.
• Will be required to work regular office hours at the designated facility.
• This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required.
• This organization reserves the right to revise or change job duties as the need arises.
• Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities.
• This job description does not constitute a written or implied contract of employment.

JOB DESCRIPTION

• Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information.

JOB QUALIFICATIONS

• Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application).
• Knowledge of Centricity is a strong plus.
• Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care’s, Medicaid and Private Pay.
• Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems.
• Strong written and verbal communication skills.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Knowledge of the center’s Policies and Procedures.
• Ability to maintain records and prepare reports and correspondence related to the position.
• Ability to work directly with upper leadership regarding claims issues and resolutions.
• Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others.

EDUCATION:

• High school diploma or equivalent required.

Experience / Knowledge:

• Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties.

NOTE: THE JOB DUTIES LISTED ARE TYPICAL DUTIES OF THE WORK PERFORMED. NOT ALL DUTIES ASSIGNED TO EVERY POSITION ARE INCLUDED, NOR IS IT EXPECTED THAT ALL POSITIONS WILL BE ASSIGNED TO EVERY DUTY.

• Analyzes designated eligibility reports on a daily basis.
• Communicates with and advises Insurance Verification Team Leader of all questions problems related to insurance verification.
• Adheres to all policies and procedures related to compliance with all federal and state billing regulations.
• Communicates with billing representatives regarding any insurance issues that may arise.
• Maintains a positive and professional attitude.
• Reads all emails and responds accordingly in a timely manner.
• Listens to all voicemails and respond accordingly in a timely manner.
• Works with members of various teams and/or departments on identifying process improvements.
• Possess flexibility to work overtime as dictated by department/organization needs.
• Assists in determining proper courses of action for resolution to insurance issues.
• Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Possesses strong ability to think outside the box.
• Has the ability to work in a high stress/demanding environment.
• Performs additional duties as requested by Team Leads or Management Team.