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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