Regional Insurance Verification Specialist

Responsible for supporting facilities within the region on verifying assigned patient insurance benefits in a timely manner. Preparing and providing patient estimates of financial responsibility. Maintains optimal patient, referring physician, and insurance company satisfaction.

• Ensure all records are maintained in absolute integrity and in compliance with applicable regulations and requirements.
• Obtaining or updating required referrals and authorizations via phone, fax, on-line, etc.
• Review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification.
• Data entry in a fast-paced environment with high expectations on accuracy.
• Updates the patient account with details of the insurance verification.
• Coordinating with patients regarding their insurance benefits.
• Identifies deductibles, co-pays, and self-pay accounts.
• Notifying the appropriate staff members if treatment or service is denied.
• Assist manager and other staff with account questions when presented.
• Perform other duties as assigned.
• Rely on experience and judgment to plan and accomplish goals.

• High School Diploma or equivalent
• 1-2 years of related revenue cycle experience in healthcare (ASC preferred)

• Knowledge of revenue cycle in healthcare
• Knowledge of clinic policies and procedures.
• Knowledge of managed care contracts and utilization.
• Knowledge of computer systems, programs, and spreadsheet applications.
• Knowledge of medical terminology.
• Knowledge of CPTS/ICD-9

• Skill in gathering and reporting claim information.
• Skill in solving utilization problems.
• Skill in written and verbal communication and customer relations.

• Ability to work effectively with billing and medical staff and external agencies.
• Ability to identify, analyze and solve problems.
• Ability to practice time management
• Ability to prioritize and stay organized

Requires sitting and standing associated with a normal office environment.

• Employee must ensure they have an environment appropriate for work purposes that includes telephone and computer work.
• Employee must have appropriate telephone and secure internet connections suitable to meet role requirements.
• Employee must have quiet, private space to maintain confidentiality.
• The location must allow the employee to devote his/her attention to work during expected work hours.
• Employee must be able to carry out same duties, assignments, and work obligations at their home office as they would when working on premises.
• Workweek remains the same as the scheduled working hours for the CBO
• Employee must receive prior approval for any time away from work other than meal breaks.
• Employee must be available by teams, phone, and email during work hours.
• Employee must be available to attend required training and meetings via teams.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.