Job Description

Job Description

Job Description

SUMMARY

The Insurance Verification Specialist is responsible for ensuring that patients are properly pre-certified for insurance coverage prior to their appointment

We are looking for a detail-oriented insurance verification specialist to join our team. You will be responsible for verifying insurance benefits and eligibility. Verification includes verifying the applicant’s address, insurance information, and other eligibility requirements. This is under the direct supervision of the Insurance Verification Team Leader.

MINIMUM QUALIFICATIONS

Education and Experience:

• High school diploma or GED required
• Medical and or Vision insurance benefits verification experience preferred

ESSENTIAL SKILLS AND ABILITIES

• Proficient computer skills
• Ability problem solve
• Detailed oriented
• Develop an understanding of Medicare, Medicaid and commercial insurance
• Develop a complete understanding of Medicare, Medicaid, HMO and Commercial Insurance plans and eligibility requirements.
• Ability to understanding of ICD-9/10 and CPT Coding for Ophthalmology
• Excellent communication skills, proper grammar and writing capability
• Team-oriented
• Self-directed, highly motivated, able to multi-task, and work under pressure in a fast-paced environment
• Exceptional interpersonal skills
• Possess a caring, patient, and friendly attitude
• Familiarity with all forms associated with the patient’s medical record
• Understand ophthalmic terms
• General understanding of ophthalmic diseases

DUTIES AND RESPONSIBILITIES

1. Retrieve the appointment list of patients two to five days before their visit and perform insurance verification for both medical and vision coverage as assigned
2. Verify whether the plan coverage is Primary or Secondary, HMO, PPO, or Commercial Carrier Insurance
3. Verify optical plan vision benefits coverage including deductibles and co-pays
4. Properly document plan coverage in the patient’s “alert” section of the medical record
5. Verify the out-of-network requirements/benefits for each patient
6. Verify the status of deductibles and requirements of various co-pays
7. Verify emergency and walk-in patients as requested
8. Post all verification corrections/additions to the patient’s account as needed
9. Maintain proper insurance verification documentation in the patient’s medical record
10. Verifies clinic benefits for retina schedules and verifies surgical level benefits for all evaluations.
11. Verify whether we have a referral or authorization already on file or if a new request needs to be created.
12. Creating a referral or authorization request using the CPT Procedure code fax form and sending it with all appropriate patient chart notes for approval to the primary care physician.
13. Review all insurance page fields for accuracy
14. Communicate with insurance carriers in a pleasant and expeditious manner for insurance verification and/or troubleshooting
15. Communicate with patients on insurance updates, questions, explanations of benefits and appointments
16. Communicate with ESMF staff on all insurance-related questions, explanations of benefits, and appointments
17. Correct any demographic or insurance information that is not accurate
18. Input any demographics, referral, or patient information into the practice management software

19. Professional and Personal Development/Goals and Objectives

1. Exhibit professional demeanor with a positive attitude at all times when representing the practice
2. Must attend all in-services and webinar training as directed by the Patient Services Lead or the Director of Managed Care
3. Set goals and objectives for professional growth. Review and revise goals on an ongoing basis
4. Provide input on how to improve customer service, decrease costs, and increase revenues for the practice

20. Customer Service

1. Support the practice's core values and mission statement to develop, enhance, and promote quality customer service through team effort
2. Exhibit flexibility, sensitivity, and respect while maintaining an effective working relationship with all team members

21. Maintain practice confidentiality, follow HIPAA & OSHA guidelines and the rules and regulations of the practice as documented

22. Maintain proper standards of productivity as defined by management

23. Perform other duties as assigned

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job

• The majority of the time on-the-job is spent walking and sitting
• At times the job may require weight to be lifted up to 50 pounds
• The job requires the following types of vision: close, distance, peripheral and depth perception
• Typical noise level for the work environment of this job is moderate (i.e. business office with computers and printers, light traffic)
• Must be able to communicate clearly in person and over the telephone
• Hearing must be adequate to perform job duties in person and over the telephone
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

OTHER

This job description is intended only to describe the general nature and level of work performed. The Insurance Verification Captain must be able to travel to various satellite locations as needed for work assignments. A valid Florida driver’s license is required. This job description is not intended nor should it be interpreted as an exhaustive list of all duties, skills and responsibilities. The Insurance Verification Specialist will perform all duties listed in this job description as well as any other assigned by the departmental supervisor. Overtime may be required.

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