Insurance Change Specialist

Duties:

• Obtains patient demographic and health insurance information; collects co-pay(s) when appropriate.
• Verifies and records insurance benefits with the ability to understand and provide insurance breakdowns.
• If required by payer(s), obtains prior authorization &/or follows up on authorization daily.
• Able to read through and understand medical documentation effectively
• Resolves Front Collections accounts as well as documenting within computer system appropriately.
• Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
• Performs other clerical tasks as needed, such as
  1. Answering patient/Insurance calls
  2. Faxing and Emails
• Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
• Other responsibilities and projects as assigned.

 

Requirements:          

• High School Diploma or equivalent.
• Learns and maintains knowledge of current patient database and billing system
• Verifying Insurance for all products
• Understand Insurance benefit breakdown of deductibles and co-ins
• Understand Insurance Medical and Payment Policies
• Knowledge of Explanation of Benefits from insurance companies
• General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.

 

Experience:

• 2-4 Years in DME or Medical Office experience preferred.
• Minimum of 1 year of insurance verification or authorizations required.

 

Skills:

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral)