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The Insurance Verification Representative is responsible for researching and updating the insurance information, commercial and government, within various databases with the current benefit status for each patient. Information can be obtained electronically or by direct communication with the insurance companies
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Responsible for verifying patient insurance coverage
Responsible for taking data provided and submitting claims to various private and government sponsored insurance companies
Follow up with pending claims and work denials for all payers
Query information on remote Medicare software
Learn new systems and process solutions as they present themselves to ensure proper assignment and workflow
Contacts insurance companies/payers or patients to gather information necessary to complete appeal processing
Remain compliant with our policies, process and legal guidelines
Will need to be open to ongoing feedback and coaching aimed at improving performance
Remain compliant with HIPPA and other State and Federal regulations
Entering and/or updating the benefit information in an accurate manner into the various databases
Adhere to the production standards set for the department and client
Accuracy and confidentiality in handling medical records in compliance with HIPPA, Federal, State and Company requirements
Other duties as assigned by manager
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION & EXPERIENCE
A high school diploma or equivalent is required
2 or more years of experience within the medical industry is preferred
2 or more years of experience in medical billing required
Experience working with both government and commercial payers required
KNOWLEDGE, SKILLS, & ABILITIES
Knowledge of insurance terminology and processes
Intermediate to advanced proficiency in computer skills using Microsoft Word and Excel software
Knowledge and skill navigating insurance portals for online benefit review Medical system platform experience with STAR, EPIC, etc.
Ability to multi-task in a fast-paced environment
Excellent verbal, written and communication skills
Strong analytical/problem solving skills
High attention to detail
Ability to read and understand a variety of information presented in different formats from a variety of sources
Must be able to type a minimum of 25 wpm
PHYSICAL REQUIREMENTS
While performing the duties of this job, the employee is occasionally required to stand or walk and lift and/or move up to 25 pounds. Also may be required to use hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel or crouch or crawl; see, talk and hear.
WORK ENVIRONMENT
Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Incumbent/employee works in a temperature-controlled office environment or a Work from Home office environment. Incumbent/employee must be able to work on a computer for the scheduled shift; answers and makes telephone calls using a standard or computer soft telephone; types on a standard keyboard; reads and comprehends information from a computer terminal and/or written resources and utilizes multiple screens and systems simultaneously. All incumbents/employees are provided a Webcam and are required to be on camera 100% of the time during the scheduled shift.
Illinois, Maryland, Massachusetts, and New Jersey residents click below for compensation and benefits
