Insurance Verification Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES: • Receive assigned insurance verification requests (IVR’s) 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 prompt processing and closure of IVR’s and authorization requests • Respond to simple, routine questions from physicians, hospitals, outpatient • Determine if payer already in SalesForce database; if not, research payer on website to obtain demographic information and forward 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 complex
• Refers complex, 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 skill training; certification may be required
• 2-5 years of experience in area of responsibility
• Basic understanding of Medicare, Commercial and Medicaid health plans a plus
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