Insurance Verification Job Description
Insurance verification
provides pertinent information requested from insurance companies and documents authorization details obtained from insurance companies into appropriate database.
Insurance Verification Duties & Responsibilities
To write an effective insurance verification job description, begin by listing detailed duties, responsibilities and expectations. We have included insurance verification job description templates that you can modify and use.
Sample responsibilities for this position include:
Greeting and registering patients
Answering billing office phone
Scanning Insurance ID cards
Scanning EOB’s and other documents
Sending insurance bills, patient statements, and patient forms (both paper and electronic)
Collects demographic, insurance and financial data for the purpose of organizing, analysing and translating this information into useful data that meets our customers needs supports organizational goals, and meets regulatory and compliance requirements
Ensures complete and accurate demographic, third party payer collection required billing information
Contact patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at the time of the appointment
Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary
You will be responsible for timely and accurate pre-certification and insurance verification
Insurance Verification Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Insurance Verification
List any licenses or certifications required by the position: CHAA
Education for Insurance Verification
Typically a job would require a certain level of education.
Employers hiring for the insurance verification job most commonly would prefer for their future employee to have a relevant degree such as High School and Associate Degree in Education, Medical Billing, Associates, Business, General Education, Medical, Business/Administration, Technical, Healthcare, Accounting
Skills for Insurance Verification
Desired skills for insurance verification include:
Medical terminology
Medical terminology and procedures
Medical billing procedures
State
Federal
Medical insurance/authorization process
Medicaid and other government contracts and guidelines and workmen’s compensation fee schedule
Medicaid and commercial carriers
Reimbursements from insurance companies and government payers
Accreditation regulations governing home care
Desired experience for insurance verification includes:
Ability to work proficiently with company software used on the project
You will accurately interpret managed care contracts and is proficient in the use of the Contrak system
3 years of insurance verification experience is preferred
You will need to pass a typing test with scores of at least 30wpm and 3 or fewer errors prior to interviewing
Determines patient portions due, amounts to be billed, contractual discounts to be taken, or any other authorized discounts that may apply
Accurately completes data entry necessary including authorizations and benefits patient communication in the appropriate module of AdvantX
Insurance Verification Examples
1
Insurance Verification Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of insurance verification. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance verification
- Controls department staffing according to budgetary guidelines and as volume warrants
- Performs daily QA of pre-registration/insurance verification work processes
- Tracks, trends, and reports performance by employee/department
- Daily review, maintenance, and biweekly preparation and submission of employee time sheets as required
- Works closely with facilities as necessary to ensure successful integration of facility needs and SSC standards
- Responds timely to requests for information or assistance from all levels
- Works daily PA and Meditech reports (as defined by supervisor) to ensure accurate and timely account follow up
- Meets weekly with supervisor to review department operations and productivity measures
- Defines upfront collection goals each month and works with staff to ensure goals are met per SSC standards and guidelines
- Promptly addresses all personnel or performance related issues, documenting each encounter
Qualifications for insurance verification
- Supports and contributes to SSC Education programs
- Maintains quality Performance Improvement program and documentation - solicits input from staff and offers ideas for improvement on a regular basis
- Completes monthly reports as assigned
- Effectively communicates with staff in writing via the appropriate communication system to back up verbalization
- Conducts monthly staff meetings and in-services
- Screens applicants and performs initial interview
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Insurance Verification Job Description
Job Description Example
Our company is growing rapidly and is looking for an insurance verification. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance verification
- Responsible for ensuring insurance companies are contacted to complete the verification process through phone calls and/or web based sites and/or is responsible for obtaining authorizations/ pre-certifications from insurance companies and radiology management companies
- Documents the insurance and authorization verification information in the applicable computer system in accordance with documented work processes
- Ensures authorizations /pre-certifications issued are correct
- Interfaces with customers and Alliance’s managed care department regarding any contracting issues
- Acts as source of reference for team members
- Assign Iplans accurately, via the use of the Contrak system
- Research Patient Visit History to ensure compliance with the Medicare 72 hour rule
- Receive and record payments from patient for services rendered
- Utilize Meditech MOX communication system to facilitate communication with hospital gatekeeper
- Utilize Meditech account notes and Collections System account notes as appropriate to cut-n-paste benefit and pre-authorization information and to document key information
Qualifications for insurance verification
- Computer literacy required, experience with medical scheduling/billing systems is desired
- Utilize appropriate communication system to facilitate communication with facility PTAC and other departments as required
- Assists manager with the QA process as requested
- Prior insurance verification experience required, at least three years preferred
- Responsible for ensuring insurance companies are contacted to complete the verification process through phone calls and/or web based sites
- Provides support for the scheduling and pre-registration departments as needed
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Insurance Verification Job Description
Job Description Example
Our growing company is hiring for an insurance verification. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance verification
- Responsible for understanding the complexities of health plans and the relationship between health plans , Medicare, MaineCare, Commercial Insurances, Blue Cross, Worker's Compensations, and self-pay
- Using multiple computer systems in order to work efficiently
- Ensures workload is distributed among benefit verification associates
- Ensures team communicates and complies with deadlines, including expected turn around times of referrals and authorizations
- Ensures timely re-authorization for prior authorizations, to prevent expiration of authorization, in order to ensure payment and continuation of patient therapy
- Responsible for quality of verifications, as shown by internal QA review activities, triage review, reimbursement activities tied to those patients verified
- Responds to inquiries regarding verifications
- Handles escalated situations, including complex or difficult benefit investigation and/or communication with physician offices and patients
- Responsible for exceptional customer service with patients and physician offices
- Manages communication with commercial sales team regarding patient statuses
Qualifications for insurance verification
- Minimum 1-2 years’ experience in a retail or mail order pharmacy preferred
- Knowledge of Insurance benefit coordination
- Requires broad training in fields such as business administration, accountancy, sales or similar vocations generally obtained through completion of a four year Bachelor's Degree Program or equivalent combination of experience and education
- Knowledge of Medicare, B, D and C and Medicaid plans is preferred
- Proficiency computer and data entry skills
- Prefer 1+ years’ of experience working with insurance verification, verifying insurance, or other related duties in a medical facility, clinic, hospital, outpatient surgery center, or health-care industry
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Insurance Verification Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of insurance verification. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance verification
- Manages patient financial assistance process, including ensuring that all avenues are explored and exhausted to enable a patient to afford medication therapy
- Responsible for proper documentation and communication of benefit investigation results and patient assistance efforts, including documentation in pharmacy management system
- Aggressively pursues opportunities for business to keep patients on service
- Works with Managed Care team and contracting to identify and seek contracting opportunities and contract issues, including expired contracts and/or reimbursement rates as they arise in the operation
- Coordinates referral hand-off with scheduling team
- Coordinates with all branches to ensure timely and accurate delivery of referrals and tasks for incoming information pertaining to patient records
- Provides direct support to staff
- Handles team supervision, coaching, discipline, payroll, scheduling, and other HR related activities
- Trains and provides direction on procedures and processes to associates
- Ensures a continuous quality improvement customer service approach by proactively identifying areas of improvement and communicating those ideas to the team
Qualifications for insurance verification
- Accepts and gives constructive feedback
- Sets priorities and can adjust to meet department demands or changes
- Works as a team with other department staff
- Stays current on knowledge relevant to the position
- Be responsible for oversight of the insurance verification and authorization process
- Maintain policies and procedures to ensure timely communication of verification and authorization status to field locations, providing necessary information to facilitate decision making for patient admission and visit utilization coverage
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Insurance Verification Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of insurance verification. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance verification
- Amulance experience is strongly preferred
- Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission including knowledge of the grievance and/or reconsideration process
- Ability to handle complex claim submission and follow up
- Funding, and three day rule
- Manages quarterly Medicare credit balance report and resolves open credit balances
- Utilizes all resources available, including electronic inquiries to verify eligibility, benefits, and claim status
- Resolves Return to Provider (RTP) claims using Direct Date Entry (DDE)
- Enters Hospice Notice of Election (NOE) claims via DDE
- Researches problem accounts and take necessary action and/or make recommendations to ensure timely resolution of account balances and resolve credit balance accounts
- Contact patient for additional information in order to have claims processed and paid in a timely manner
Qualifications for insurance verification
- 1 – 2 years’ experience in medical or related field required
- Experience with medical scheduling/billing systems is desired
- Skilled in 10-key and general office machinery
- Perform routine review of outstanding requests and redirects workload as appropriate
- Coordinate communication with the contracting department on payer related issues as appropriate
- Ensure effective communication among team members