Insurance Verification Specialist

Summary

The Insurance Verification Specialist performs insurance verification for CODAC members. Responsibilities include but not limited to heavy phone contact with managed care companies, communicate with insurance companies authorization department regarding any CPT code discrepancies (as assigned), and contact patient prior to appointment if there is any insurance/ authorization issues.

Essential Duties and Responsibilities

1. Responsible for pre-certification/ authorization and insurance verification for all patients
2. Contacts insurance plans to determine eligibility and obtain coverage and benefit information.
3. Contacts insurance plans to obtain prior authorization for services.
4. Calculate cash estimates for patients on upcoming visits/ procedures.
5. Contact patients regarding financial obligations.
6. Processes request for prior authorization from clinics.
7. Research, follow up and resolve open & pending authorizations in a timely manner
8. Documents findings thoroughly and accurately.
9. Performs training with organizational staff on procedures for requesting, documenting and processing prior authorizations.
10. Prioritizes work to maximize turn-around time.
11. Maintain clear communication with patients as well as insurance companies.
12. Maintain an error rate in accordance with departmental policy.
13. Makes changes to demographic information as necessary in order to produce a clean patient statement.
14. Answer and respond to external and internal phone calls in a timely manner.
15. Check and respond to emails in a timely and professional manner.
16. Performs other duties as assigned in keeping with the growth and general responsibilities of the position.

Education

• High school diploma or equivalent, AND a minimum of 1 year insurance verification experience.

Other:

• Bilingual skills a plus.
• Use of Microsoft Office programs Word, Excel, and Outlook.

Skills:

1. Familiarity with a variety of computer software used for researching, tracking, data entry/processing, and reporting information, i.e. AHCCCS Online, Excel, Word, and various statistical or graphics programs.
2. Knowledge of administrative procedures, office equipment, and principals for providing excellent customer service.
3. Knowledge of electronic health systems, records standards, and current statutes pertaining to protected health information while maintaining confidentiality and compliance with HIPAA and other privacy regulations.
4. Knowledge of AHCCCS, insurance benefits, and determination of eligibility and/or enrollment.
5. Ability to maintain professional appearance, demeanor, and working relationships with staff, members, visitors, and the community at large.
6. Ability to apply tactful, adaptable, and professional communication skills with a variety of personalities, cultures, and linguistically diverse backgrounds.
7. Ability to evaluate facts or situations to determine appropriate actions and resolutions.
8. Ability multi-task, anticipate workflow, plan and prioritize while working with frequent interruptions in a fast-paced environment.
9. Ability to work independently and as a team to coordinate and make decisions, follow-through with all tasks, and escalate crisis situations to the appropriate staff.