Insurance Verification Specialist

Insurance Verification Specialist

Job description

Summary:
The Insurance Verification Specialist is responsible for ensuring that patients are properly pre-authorized/certified for insurance coverage prior to their appointment and/or surgical appointment.

Minimum Qualifications:
Education & Experience
- High School Diploma or equivalent required
- Insurance verification experience preferred

Essential Skills and Abilities:

- Proficient computer skills
- Proficient phone skills
- Detail Oriented
- Ability to problem solve
- Ability to work in a fast-paced environment while maintaining accuracy

- Ability to work well in a team environment
- Self-directed, highly motivated, and ability to multi-task
- Excellent communication skills, proper grammar and writing capability
- Possess a caring, patient, and friendly attitude
- Excellent organizational skills

- Knowledge of or ability to learn understanding of ophthalmic diseases, terms and spelling of same

Duties:
- Verify eligibility of applicants by completing required forms, phone calls, or face-to-face interviews
- Verify patient’s address, insurance information, and other eligibility requirements
- Enter data into systems and databases
- Verifies whether the plan coverage is Primary or Secondary; HMO, PPO or Commercial Carrier Insurance
- Verifies optical plan coverage including deductibles and co-pays

- Properly documents plan coverage in the patient’s alert section of the medical record

- Verifies the out-of-network requirements/benefits for each patient

- Verifies the status of deductible and requirements of various co-pays

- Process insurance claims and handle insurance verification rejections

- Maintain accurate records by following proper documentation requirements

- Work closely with other departments to ensure that all processes are running smoothly
- Knowledge of or ability to learn complete understanding of Medicare, Medicaid, HMO and commercial insurance plans and eligibility requirements
- Knowledge of or ability to learn complete understanding of all forms (paper & electronic) associated with the patient’s medical record
- Knowledge of or ability to learn complete understanding of ICD-9/10 and CPT Coding for Ophthalmology
- Assist in the development of new policies and procedures by providing information to management or other departments as needed
- Other duties as assigned
 

Other:
- This job description is intended only to describe the general nature and level of work performed and should not be interpreted as an exhaustive list of all duties, skills, and responsibilities.
- A valid Florida driver’s license and reliable transportation is required as this position may be required to travel to various satellite locations as needed for work assignments.
 

Job Type: Full-time
 

Expected Hours: 40 per week
 

Schedule:
- Monday to Friday
- One early morning or late night per week may be required
- Must be able to attend one monthly meeting before or after normal business hours (advance notice will be provided)
- Must be able to attend one monthly training event before or after normal business hours or on a Saturday (advance notice will be provided)
 

Work Setting:
- In-Person
- Private Practice
 

Benefits:

- 401(k)
- 401(k) Matching
- Accidental Death & Dismemberment (AD&D) Insurance
- Health Insurance
- Health Savings Account
- Dental Insurance
- Disability Insurance
- Life Insurance
- Vision Benefits & Discounted Services
- Employee Assistance Program
- Employee Discount

- Opportunities for Advancement
- Paid Time Off

- Paid Training
- Professional Development Assistance
- Referral Program

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Eye Specialists of Mid-Florida is an Equal Opportunity Employer. We do not discriminate against any individual based on race, color, religion, sex, national origin, age, disability, genetic information, military status, or any other characteristic protected by law. We are a drug and tobacco-free workplace.