Insurance Verification Specialist

Insurance Verification Specialist role at Physical Rehabilitation Network (PRN)

• Position:
  Verifications Specialist
• Job Type: Full-time (40 hours a week)
• Pay: $16.50 - $18.50 per hour
• Remote:
  Applicants must reside in ND, SD, , MN, MT, NM, WY, NV, TX, AZ, TN, MO, or OK.

The Verification Representative is responsible for verifying and obtaining eligibility and benefits as required by insurance companies based on plan coverage for all patients in the region. The role reports to the Verification Supervisor and involves data entry into billing software, maintaining contact with office locations, coordinating with regional Patient Service Representatives, preparing daily activity reports, scanning pertinent information into patient charts, managing schedule reports, resolving referrals or billing issues, and following standardized processes and workflow.

• Answer calls from regional office locations, insurance companies, and representatives using exemplary customer service skills.
• Accurately enter and scan required information into computer database.
• Follow standardized processes and workflow as required for job functions.
• Review structured regional clinical data matching it against specified encounter(s) and follow established procedures for authorizing request and establishing benefits and eligibility for said encounter(s).
• Enter obtained information with precertification numbers as needed.
• Report data two to three times daily, emphasizing daily encounters scheduled and new patient same-day encounters.
• Maintain patient confidentiality as defined by state, federal, and company regulations.
• Review errors and denials for regional assigned clinics and communicate these issues back to the Verification Supervisor.
• Establish effective rapport with employees, professional support staff, customers, patients, families, and clinicians.
• Have EHR familiarity with note retrieval.
• Actively support departmental and corporate strategic plans to ensure successful implementation.
• Maintain cooperative working relationships with all clinic PSR staff and clinicians.
• Research and correct invalid or incorrect patient demographic information such as date of birth or insurance policy number.
• Respond professionally to all inquiries from patients, staff, and payors in a timely manner.
• Inform management of changes in authorization process, insurance policies, billing requirements, and credentialing issues as they pertain to claim processing.
• Accurately document patient accounts of all actions taken.
• Establish and maintain a professional relationship with all staff to resolve problems and increase knowledge of account management.
• Communicate with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
• Inform management of any billing concerns, backlogs, insurance issues, problem accounts, and available time for additional tasks.
• As necessary, negotiate a work improvement plan with management to raise work quality and quantity to standards.
• Complete additional projects and duties as assigned.
• This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.

• Demonstrates overall knowledge of authorization, benefits, and claims processing for insurance companies and plans both private and government.
• Demonstrates the ability to make decisions, assess and resolve problems effectively.
• Demonstrates the ability to carry out assignments independently, following procedures, and exercise good judgement.
• Demonstrates the ability to maintain the confidentiality of all records.
• Demonstrates ability to manage multiple tasks and demands given tight time constraints while ensuring high accuracy and attention to detail.
• Effective interpersonal skills in a diverse population.
• Ability to use computer and phone for extended periods of time.
• Proven effectiveness in verbal and written communication.
• Demonstrates overall knowledge of verification and authorization processing for insurance companies, including private, commercial, and government carriers.
• Demonstrates overall knowledge of managed care plans.
• Demonstrates overall knowledge of workers compensation rules and guidelines for claim authorization and payment.
• Must be able to communicate effectively and foster positive relationships.
• Word-processing and spreadsheet application knowledge is preferred.
• Ability to work independently with minimal supervision as well as ability to work in a team environment.
• Skilled at managing multiple projects and grasping new concepts.
• Knowledge of healthcare industry with emphasis on benefits, eligibility, and authorizations.
• Accurately complete assignments while meeting deadlines.
• Excellent organization skills.
• Excellent internal and external customer service skills.
• Must possess good oral and written communication skills and recognize importance of teamwork.

• High School Diploma or…