Insurance Verification Specialist (on-site required)

Company: e CancerCare
Location: Garland
Posted on: January 25, 2023

Job Description:

Job Purpose: The Specialist is responsible for insurance verification processes of verifying patient eligibility, coordinating medical benefits, gaining approval for planned procedures and services, and determining patient coverage / responsibility for services to be provided. Essential Functions: Verify private, government and third party insurance information, including eligibility, out-of-pocket costs, prescription coverage and patient portions. Verify any secondary and tertiary medical insurance benefits. Obtain, review and input insurance authorization and referrals prior to patient services, and throughout treatment to maintain continuance of authorizations. Advocate for the patient utilizing knowledge of coverage based guidelines and treatments. Provide accurate and timely estimated patient responsibility amounts to patient service staff members. Monitor and track patient authorizations, obtain updated authorizations for ongoing treatment, and communicate changes to appropriate team members. Identifies and provides accurate CPT/ICD codes where needed for reimbursement. Maintain appropriate logs and reports to professional, state and federal requirements; including but not limited to Medicaid, Medicare, case logs and drug logs. Obtains, interprets and submits clinical documentation pertinent to the specific services requiring prior authorization to support medical necessity reviews by the payer. Follows up on denied authorization requests, escalates to appointed appeal personnel, and relays the necessary denial detail to the provider to facilitate the appeal and/or peer to peer reviews. Work closely with Financial Counselor, Patient Navigator and front office staff to ensure smooth collection process. Maintains appropriate documentation in clinic systems and EMR. Other responsibilities as required. Regular attendance and punctuality. Contributes to team effort by accomplishing related results as needed. Ensures that all processing and reporting deadlines are consistently achieved. Perform any other functions as required by management. Qualifications and Education Requirements Minimum of 2 years in this field or related field such as medical coding, financial counseling setting or similar service profession. Strong knowledge of ICD9/10 diagnosis codes, as well as CPT codes. Must be proficient using a computer, online websites, and email. Knowledge of basic medical terminology Ability to work a flexible schedule (including overtime, and weekends, as necessary). High school graduate or equivalent Preferred Skills Previous oncology background preferred Required Competencies Strong Business and Organizational Competence. - Exceptional Customer Service Skills. - Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking. Physical Demands and work environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing. Work environment: - Required job duties are normally performed in a climate-controlled office environment.

Keywords: e CancerCare, Garland , Insurance Verification Specialist (on-site required), Other , Garland, Texas