Hoag Looking for Insurance Verification Specialist – Patient Accounting Job Details | Hoag at United States Full Time

Full Job Description

The Insurance Verification (IV) Specialist is responsible for
insurance and benefit verification processing for surgeries,
admissions, OP Radiology, and all other services as assigned. Works
directly with patients, internal and external business partners (I.e.
IPAs and insurance companies), and clinical departments for delivery
of services to include but is not limited to: verification of
insurance benefit and coverage, explanation of clinical documentation
to support proper authorization and level of service, obtaining
authorizations for services, and for accuracy of benefit data to
insure timely reimbursement of services. Has expert knowledge of
deductibles, copayments, coinsurance, CPT and Diagnosis/Procedure
Codes, Medical policies, LCD’s and Medical terminology. Works
efficiently to ensure documentation and notification is processed in a
timely manner. Strives within a team atmosphere, has strong customer
service expertise, has ability to multi-task, and proficient computer
skills.

Essential Functions

Insurance Verification Specialist – Level I:

• Verify insurance coverage for all assigned patients.
  Ensure procedure is covered under the patient’s plan and guidelines.
• Accurately code insurance in the billing system to ensure
  timely billing. Document all copayments, co-insurance and deductible
  limits. Determine out-of-pocket cost and provide patient price
  estimates.
• Generate task reports to monitor workload and
  inventory. Seeks assistance when needed to maintain 100% service level
  targets.
• Arrange for peer-to-peer evaluations between
  physician offices and insurance companies as requested.
• Provide patient education of service benefits, status of
  pending or denied authorizations and for limited benefit coverage.
• Seeks assistance to maintain service level and to avoid
  delays in patient care. Avoids cancellation of service at all cost.
• Perform other duties as assigned.

Education, Training and Experience

Required:

Level 1:

• High School diploma or equivalent with three (2-3) years
  of patient access or related healthcare experience.

Preferred:

Level 1:

• Background in billing, insurance verification, coding,
  patient access or appointment scheduling. Degree and/or certificates
  in related field.

Skills or Other
Qualifications

Required:

• Intermediate level knowledge of Windows computers with a
  solid keyboard data entry skills and working knowledge of basic office
  equipment.
• Ability to multitask consistently and tolerate
  interruptions.
• Good organizational and follow-through skills.
• Excellent communication skills, interpersonal written and
  verbal.

Preferred:

• Possesses thorough knowledge of insurance verification and
  authorization guidelines for hospital inpatient, surgical, and
  outpatient services.(including insurance requirements and guidelines,
  ICD-10 and CPT 4 coding).
• Knowledge and understanding of
  benefit plans, plan and coverage, and claims responsibility.
• Strong grasp on medical terminology.