Insurance Verification Specialist Resume Samples

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V Kuhn

Vladimir

Kuhn

3612 Hauck Meadow

Dallas

+1 (555) 630 9137

3612 Hauck Meadow

Dallas

Phone

p +1 (555) 630 9137

Experience Experience

Detroit, MI

Insurance Verification Specialist

Detroit, MI

Price-Turner

Detroit, MI

Insurance Verification Specialist

Develops effective working relationships with internal and external clients
Performance-based compensation and rewards for your hard work
Proactively identify areas of improvements within daily work activities
Demonstrated knowledge of Pharmacy Benefit Managers and how to obtain this information from Insurance companies
Work with the branch Admissions team to gather documentation for new patient processing
Contact pharmacy benefit manager to obtain formulary restrictions and copays on specific medications
Request authorization for payment from insurance provider

Phoenix, AZ

Insurance Verification Specialist Acacia OB

Phoenix, AZ

Ledner-Reynolds

Phoenix, AZ

Insurance Verification Specialist Acacia OB

Notify manager with patient account and insurance issues
Ensure and assist patients in obtaining proper insurance referrals and prior authorizations before their visit
Input patient demographic and insurance information into computer system
Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement
Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources
Coordinate registration of new patients via phone calls or in office
Track referral and prior authorization process and communicate to CBO

present

Dallas, TX

Senior Insurance Verification Specialist

Dallas, TX

Baumbach and Sons

present

Dallas, TX

Senior Insurance Verification Specialist

present

Verifies patient insurance coverage of medications, administration supplies and related pharmacy services
Subject matter expert in completing the Prior Authorization process with insurance companies and practitioner offices; Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services
Acts as a subject matter expert in fixing and adjusting past claims including working with finance for approved claim adjustments after insurance approvals
Participates in test and implementation of system updates and new plan implementations
Assists with workflow management, issue resolution and training in addition to or in the absence of a supervisor; Assists with auditing and reporting of the other technicians including compiling AUX reporting and order audits
May assist in training of new team members and may provide input to the employees’ performance evaluations
Acts as a resource for colleagues; may direct the work of other staff members

Education Education

Bachelor’s Degree in Initiative

West Virginia University

Bachelor’s Degree in Initiative

Skills Skills

Self-motivated, enthusiastic and detail oriented with great organizational skills who works well with deadlines
Knowledge of basic medical terminology
Ability to multi-task, manage details and organize efficiently and effectively
Possesses a strong work ethic and a high level of professionalism
Be a self-starter, who is able to work independently and passionate about their profession
Knowledge of the content, intent and application of HIPAA
Knowledge of Managed Care, Commercial Insurances, and Medicare and Medicaid plans
Knowledge of CPT Codes and ICD-9/10 Codes
Adaptable to change in a rapidly growing company
Experience and competency in customer relation skills in a professional environment

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8 Insurance Verification Specialist resume templates

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Insurance Verification Specialist Resume Examples & Samples

Ability to meet production goals
Able to work between 11:30am - 8pm. Work Saturdays between 8am - 6pm, with one day off during the week
Demonstrated experience in providing customer service in a call center environment
Knowledge of Microsoft Word, Excel
Bachelor’s Degree in Finance, Accounting or a related field
Prior benefit or claims insurance knowledge

Insurance Verification Specialist Resume Examples & Samples

Comprehensive knowledge of Microsoft Word, Excel and Access
Demonstrated experience in providing customer service in a large office environment
Prior insurance benefit or claims knowledge
Prior knowledge of patient assistance programs

Insurance Verification Specialist Resume Examples & Samples

Calling Insurance payors, following up with Clients and Patients regarding financial obligations, etc
Minimum requirement of 35-45 benefit inquiries daily
Self-motivated, enthusiastic and detail oriented with great organizational skills who works well with deadlines
Be a self-starter, who is able to work independently and passionate about their profession
Computer skills should include Word and Excel
Knowledge of Managed Care, Commercial Insurances, and Medicare and Medicaid plans
Knowledge of CPT Codes and ICD-9/10 Codes
Knowledge of required documentation which can include; LMN’s, Clinical notes, Pedigree’s
Adaptable to change in a rapidly growing company
Minimum of 2+ years knowledge of Insurance benefits which includes deductibles, Co-Insurance, out of pocket, exclusions, and Prior Authorization requirements; preferably in a Diagnostic/Lab setting

Insurance Verification Specialist Resume Examples & Samples

Confirm and reschedule return appointments, as necessary
Knowledge of ICD-9, ICD-10 and CPT codes
Skill in verbal and written communication
Skill in establishing and maintaining effective working relationships with employees, policy-making bodies, third-party payers, patients, and the public
Skill in organizing work, making assignments, and achieving goals and objectives
Skill in exercising judgment and discretion in developing, applying, interpreting, and coordinating departmental policies and procedures
Ability to use EMR, other relevant computer hardware and software, telephone, copier, fax machine and other standard medical office equipment

Insurance Verification Specialist Resume Examples & Samples

Verifies coverage benefits based on the patient's policy design to estimate the Out of Pocket potentially owed by the patient for genetic testing
Obtains pre-authorization for products/tests from the applicable payers based on the documentation supporting the genetic testing (e.g. Clinical Notes, Genetic Counseling, Consent forms, ABN)
Negotiates with the patients when authorization or policy excludes coverage
Identifies payer websites or other methods to verify coverage benefits
Reports to other team members beneficiary coverage issues for process improvements
Other projects as assigned
Knowledge, skills & abilities
Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
Must have ability to adapt to a fast paced, dynamic environment
Must understand both verification and authorization guidance
Minimum certifications/educational level

Insurance Verification Specialist Resume Examples & Samples

Contact insurance companies as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections
Effectively research and resolve prescription processing rejections to ensure patients receive medications within established patient standards
Prioritize orders that have been rejected for insurance reasons, working each order timely and accurately to ensure patient service standards are met
Work closely with other pharmacy teammates to ensure all orders are received and processed timely and accurately
Clearly and concisely document all actions taken on each order to ensure all other pharmacy teammates know the current status of each order
Maintain accurate and current information as required in DaVita Rx spreadsheets for tracking and quality assurance purposes
Answer and respond to calls regarding insurance related issues in a courteous and professional manner
Other duties as assigned including but not limited to
Minimum 2 years’ experience in electronic medical claims billing, preferably in a retail or mail order pharmacy required
Demonstrated knowledge of Medicare Part D, Medicaid and commercial payors
Prior experience using RxExpress highly desirable

Insurance Verification Specialist Resume Examples & Samples

Associate’s Degree in Accounting, or equivalent experience
Demonstrated experience analyzing Accounts Receivable accounts
Working knowledge of PMHS
Prior accounting or related finance experience

Insurance Verification Specialist Resume Examples & Samples

Work with all 3rd party payers to determine coverage requirements and confirm that the referral meets or does not meet that payer’s coverage requirements
Communicating with MD Office to obtain or provide required info for insurance verification or prior authorization, including PA denial and appeal follow up
High School diploma or equivalent required; some college preferred
Minimum typing speed - 35 wpm
Bilingual - Spanish (preferred)

Insurance Verification Specialist Resume Examples & Samples

The ability to communication effectively both verbally and written
The ability to work independently as well as in a group setting
Knowledge of insurance benefit processes
Knowledge of basic medical terminology

Insurance Verification Specialist Resume Examples & Samples

1+ years experience in insurance verification
Customer call center environment experience
Knowledge of state Medicaid systems
Researches and verifies eligibility information via online lookups to carrier eligibility websites or by phone with various carriers and updates the state MMIS system
Loads a minimum of 20-25 adds per day into the state MMIS system and terminates existing TPL insurance policies
Answers incoming calls from providers, Medicaid recipients, and other entities in relation to private/commercial insurance
Maintains an accuracy of 99% or above on all work activities per contractual obligation with state
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
Ability to work proficiently with company software used on the project (i.e. Microsoft Word, Excel, Image Now, etc.)
Ability to navigate various websites
Working knowledge of HIPAA privacy and security rules
Ability to work independently to meet objectives
Develops effective working relationships with internal and external clients
Adheres to corporate and office policies
Maintains an accuracy of 99% or above on all work activities-per contractual obligation with state
Proactively identify areas of improvements within daily work activities

Medical Insurance Verification Specialist Resume Examples & Samples

Verify eligibility and determine patient benefit coverage and product allowable
Obtain and confirm the necessary dispensing order/ documentation on file
Complete pre-certification/authorization. Obtain additional information such as medical necessity, letter of medical necessity or charts notes to submit for prior authorization
Confirm Authorization/Orders are qualified prior to shipping. Release order for shipping once verification and necessary shipping requirements have been met
Work with vendor billing and reimbursement services to resolve any verification issues as appropriate
Keep updated on all benefit changes for third party insurance carriers within their area of responsibility
Establish and maintain relationships with physician offices and other referral sources
Maintain confidentiality of all information
Experience working with verification, documentation and medical records
Experience applying knowledge of medical terminology and verification
Certified Coder or experience with medical coding specific to ICD-9/ ICD-10
Experience applying knowledge of HIPAA Privacy and Security Rules and CMS security requirements
Experience applying knowledge of Medicare, Medicaid and Commercial payers, its rules and reimbursement

Insurance Verification Specialist GYN Resume Examples & Samples

Ensure and assist patients in obtaining proper insurance referrals and prior authorizations before their visit
Provide assistance to front desk if needed
Knowledge of Electronic Health Systems
Knowledge of ICD-9 and CPT codes
Knowledge of the policies and procedures of the organization to complete billing tasks within compliance of the organization
Skill in multi-tasking
Skill in customer service
Skill in computer hardware and software use
Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives
Skill in analyzing situations accurately and taking effective action
Ability to multi-task, manage details and organize efficiently and effectively
Ability to read, interpret, and apply policies and procedures
Ability to set priorities among multiple requests

Insurance Verification Specialist Resume Examples & Samples

Process orders from referral sources and patients, responding to phone and fax inquiries, and resolving patient complaints
Assess patient needs and document referral requests for coordination of care
Provide information pertaining to equipment supplies and services to applicable departments in order to bring a patient on service with the Company
Coordinate with the Insurance Verification Team to process patient details and collect benefit coverage information
Relaying insurance coverage to referral sources and patients and discuss forms required for billing with patients

Insurance Verification Specialist Acacia OB Resume Examples & Samples

Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources
Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement
Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code of Conduct; adhering to federal and state laws, rules, regulations, and corporate policies and procedures policies that affect his/her specific job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner
Input patient demographic and insurance information into computer system
Input and maintain new patient account information in computer system insuring demographic/insurance data is correct
Coordinate registration of new patients via phone calls or in office
Track referral and prior authorization process and communicate to CBO
Notify manager with patient account and insurance issues
Assist with additional functions as needed
Knowledge of Accounts Receivable collection process
Ability to interact with patients, medical and administrative staff, and the public effectively

Central Insurance Verification Specialist Resume Examples & Samples

Ability to type at least 40-45 wpm
Must have computer and research skills
Extensive knowledge of different types of insurance coverage and policies
Must have the ability to work on multiple tasks at once
Must work well in a team environment
Ability to communicate well with public and other personnel in a tactful and courteous manner
Must have 5+ years of experience
Responsible for verifying patient insurance coverage to ensure therapy treatment is covered for new patients 48 hours prior to appointment as well as assist front office with add-ons
Understand and articulate information to treating provider as needed
Enter data such as insurance information into patient account
Requires extensive time on phone and provider websites daily
Sitting for long periods of time
Be a valuable resource to Front Office Staff and patients
Protect PHI and follow HIPPA regulations

Insurance Verification Specialist Resume Examples & Samples

High school graduate or GED equivalent required
Two years of experience with insurance verification. In-depth knowledge of insurance websites and reading eligibility
Two years of cashiering experience including one year of cashiering experience in a health care organization (may waive one year experience with Associates' Degree)
Knowledge of health center cash payment policies and procedures
A good knowledge of health care office functions
Good accuracy with numbers
Good interpersonal communication skills and ability to work effectively as a team member
Ability to make simple mathematical computations
Knowledge of data entry and use of computers required

Insurance Verification Specialist Resume Examples & Samples

Calls insurance companies to verify benefits of the patient
Completes insurance verification and summary of reimbursement and liability forms
Reviews demographic and insurance information in patient accounts and make necessary corrections as needed
Notes in each account a brief summary of information received from the insurance company
Ensures all insurance, demographic, and eligibility information is obtained and entered into the system in an accurate manner
Reviews Patient accounts to determine if treatment authorization is necessary and if so, ensures it is received
Confirms is a current referral for treatment is needed and if so confirms it is on file

Insurance Verification Specialist Resume Examples & Samples

2 years related experience in a healthcare environment preferred
Solid understanding of insurance payor reimbursement, collection practices, and accounts receivable required
Knowledge of the content, intent and application of HIPAA
Knowledge of insurance industry and basic medical terminology/abbreviations preferred
Demonstrated positive professional customer service in all patient, staff, and visitor contacts
Familiar with Microsoft Office software
Possesses a strong work ethic and a high level of professionalism
A team player who handles multiple projects simultaneously in a fast paced environment
Maintains a positive, caring attitude towards patients

Insurance Verification Specialist Resume Examples & Samples

Confirm and document patient demographic information
Comply with Center/SCA policies, procedures, missions and values
Maintain pleasant, professional relationships with all external clients when communicating issues that arise during the insurance verification process
Communicate insurance issues immediately to the surgical scheduler that prevents the process of insurance verification
Verify insurance benefits promptly and accurately. Communicate financial responsibility to patients at least five days prior to their procedure

Insurance Verification Specialist Resume Examples & Samples

Experience and competency in customer relation skills in a professional environment
Ability to work effectively as a member of a team and is self-directed
Good problem solving skills
Basic medical terminology
Exemplary keyboarding skills and experience in patient registration systems and skilled with personal computers
Ability to perform several tasks simultaneously

Insurance Verification Specialist Resume Examples & Samples

Contact insurance companies to obtain and enter accurate benefit information
Contact insurance companies to determine the pharmacy benefit manager
Contact pharmacy benefit manager to obtain formulary restrictions and copays on specific medications
Information collected is provided to facility teammates to facilitate prescribing decisions
Cross training into other departments as needed
Obtain insurance related information in a courteous and professional manner
Other duties as assigned including but not limited to working overtime with little or no notice, as needed
Demonstrated knowledge of Pharmacy Benefit Managers and how to obtain this information from Insurance companies
Demonstrated ability to think outside of the box and research information without direction from others

Senior Insurance Verification Specialist Resume Examples & Samples

Subject matter expert in completing the Prior Authorization process with insurance companies and practitioner offices; Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services
Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility; Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization on any other insurance rejections; Provides notification of urgent orders to the Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary
Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script; Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage
Acts as a subject matter expert in fixing and adjusting past claims including working with finance for approved claim adjustments after insurance approvals
Participates in test and implementation of system updates and new plan implementations
Assists with workflow management, issue resolution and training in addition to or in the absence of a supervisor; Assists with auditing and reporting of the other technicians including compiling AUX reporting and order audits
May assist in training of new team members and may provide input to the employees’ performance evaluations
Acts as a resource for colleagues; may direct the work of other staff members
Works autonomously to handle more complex issues related to patient coverage/responsibility for services
At least 2 years of experience in pharmacy benefit or medical benefit insurance billing OR 6 months of experience as an Insurance Verifier or similar position with Specialty Pharmacy
At least 2 years of experience providing customer service to team members and external customers, including meeting quality standards for services, and evaluation of customer satisfaction
Experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary
Willing to work mandatory extra hours, this may include evenings, weekends and/or hours outside of normal business hours
Basic math skills including addition, subtraction, multiplication and division
Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling)
Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns)
At least 3 years of experience in call centers
Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font)
At least 3 years of experience in a healthcare or pharmacy setting

Insurance Verification Specialist Resume Examples & Samples

Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file
Facilitates and completes the prior authorization process with insurance companies and practitioner offices
Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization and any other claim rejections
At least 1 year of insurance verification and/or pharmacy tech experience in using J-codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B&D billing, Major Medical, PBM, authorization; OR experience as an Insurance Verifier or similar position with Specialty Pharmacy
At least 1 year of experience in obtaining prior authorizations
Knowledge of and ability to explain concepts of medical benefit plan design (cost benefit, co-insurance, lifetime benefit, out-of-pocket maximum, using J-codes, CPT codes and Diagnosis codes/ route of admin /place of service)
Problem solving experience
Basic level PC skills (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents, access information on-line, etc.)
Basic Internet Explorer skills experience to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online
Keyboarding skills basic level (for example: operate by touch the letter, number, and symbol keys with minimal errors)
Pharmacy Technician License or Certification preferred unless required by state as granted by the state Board of Pharmacy or nationally recognized certification agency
Experience in calculating benefit usage balances, co-pays, days of supply, and other health insurance mathematical calculations

Insurance Verification Specialist Resume Examples & Samples

Working knowledge of billing activities and Non-Medicare Home Health payor requirements
Knowledge of Federal, State, and accreditation regulations governing home care
Proficiency with MS Office Word, Excel and Outlook
1+ year previous experience with insurance verification or Billing experience

Insurance Verification Specialist Resume Examples & Samples

Verify, interpret and accurately document patient health insurance or payment source
Estimate self-pay portions after benefits have been determined (deductibles, co-pays, non-covered services)
Document clearances and follow up efforts
Maintain CMO guidelines regarding timelines for clearances, authorizations, etc
Maintain contact and correspondence with patients and families to keep them informed of pending insurance clearances and/or coverage and/or issues
Maintain regular and timely contact with internal KKI customers (team leaders, Patient Accounting, Finance, and other department staff) regarding pending insurance clearances or coverage issues
Forward supporting documentation in a timely manner to Care Centers, patient accounting and clinical areas where applicable
Maintain browser and all IAMS Error Logs in a timely and accurate manner
1 year related experience with insurance benefit verification in a healthcare setting

Insurance Verification Specialist Resume Examples & Samples

Strong knowledge of health plans and payer information, including registration, financial securing, prior authorizations and denial processes
2+ years in insurance resolution, patient accounting or medical billing with exposure to medical terminology, financial securing, collections and patient interaction
Good Microsoft Excel and Word skills
Solid understanding of medical terminology
Outstanding interpersonal skills and ability to interact with patients, physicians, multiple internal/external department personnel, financial services and insurance payers
Vocational/ Associate Degree or education beyond High School in financial/medical related fields OR Previous experience in front-end revenue cycle workflow
4 years of experience in the insurance verification field or in a related patient financial services area, with strong medical terminology and medical billing knowledge
Knowledge of computer applications. Knowledge of payer information and health plans
Knowledge of UMPhysicians medical billing and clinics