Verification​/Authorization Clerk

Verification/Authorization Rep General Summary

Performs insurance authorizations/verification. Responsibilities include heavy phone contact with managed care companies, communicating with insurance companies’ authorization departments regarding CPT code discrepancies (as assigned), and contacting patients before appointments if there are any insurance/authorization issues. Serves as a valuable resource to patients, providing them with pertinent information on their insurance coverage.

• Responsible for authorization requests including research, follow up and resolution within a timely manner and accurately enter and document the correct insurance information and activity into the patient’s chart.
• Effectively communicate via phone with customers, employees, and vendors using exemplary customer service skills.
• Detail-oriented, organized, clean, and strong multitasking and time management skills.
• Properly complete timesheet daily.
• Maintain regular, consistent, and predictable attendance per PRO-PT’s attendance and punctuality policy.
• All other duties as assigned (e.g., assists in the training of department staff, ordering supplies, etc.).

• Knowledge of insurance guidelines including HMO/PPO, Medicare, and other payer requirements and systems.
• Knowledge and understanding of HIPAA regulations.
• Knowledge of CPT and ICD-10 coding.
• Knowledge of medical terminology.
• Strong understanding of benefits investigation; deductibles, co-insurance, out-of-pocket expenses & benefits exclusions.
• Skill to perform computer & data entry functions.
• Skill in organization and task prioritization.
• Able to operate office equipment, including but not limited to keyboard, copier, telephone, fax machine, and calculator.
• Knowledge of proper lifting techniques.
• Ability to type 40 words per minute.
• Ability to self-motivate and work effectively in an independent environment.
• Ability to recognize, evaluate, solve problems, and correct errors.
• Ability to work well in a team environment.
• Ability to successfully complete training.
• Ability to create and maintain records and write brief reports.
• Ability to communicate effectively.
• Ability to explain instructions and guidelines to others effectively.
• Ability to use a computer keyboard and mouse 6-8 hours per day.
• Ability to dial, answer, and talk on the phone 6-8 hours per day.

• High School Diploma or Equivalency.
• Minimum of one (1) year of insurance verification experience.
• Post-high school courses in insurance billing, data processing, and medical terminology (or willingness to learn) preferred.