The Insurance Verification Representative II is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies
Duties and Responsibilities
- Work effectively with insurance companies to obtain pre-certification/authorization for services
- Place calls to various health plans to obtain appropriate precertification prior to the patient's appointment
- Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
- Fax to pre-certification request form to insurance company
- Maintain files and security of confidential information utilizing host system to scan and input data as per established procedures
- Verify medical insurance information and documents in scheduling/registration modules
- Review claim denials and rejections
- Accurately enter and update patient data, and other general data, into the computer system
- Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
- Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
- Demonstrate knowledge of varied managed care insurance and regulatory guidelines
- Meet and maintain daily productivity/quality standards established in departmental policies
- Use the MPower workflow system, client host system and other tools available to collect payments and resolve accounts
- Adhere to the policies and procedures established for the client/team
- Communicate effectively with physician offices and patients
- Place outbound call to patients with precertification notification
- Work independently from assigned work queues
- Maintain confidentiality at all times
- Maintain a professional attitude
- Other duties as assigned by the management team
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- High school diploma or equivalent required
- Medical terminology knowledge required
- Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations
- Proficiency with MS Office. Must have basic Excel skillset
- Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred
- Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
- Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
- Ability to work well individually and in a team environment
- Strong organizational and task prioritization skills
- Strong communication skills/oral and written
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
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