Central Health

Insurance Verification Specialist

Req No.
2017-2992
Company
CommUnityCare Health Centers
Kramer
2115 Kramer Lane, Suite 100
Austin
Category
Administrative
TX
Type
Regular Full-Time

Overview

In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments, the Insurance Verification Specialist is responsible for verifying coverage for insured patients; informing patient of financial obligation and when prior authorization or referrals are required; and responds to all internal and external phone calls regarding patients’ insurance verification inquiries.

Responsibilities

  • Verifies third party benefit coverage to include co-pays, deductibles and co-insurance.
  • Provides excellent internal/external customer service via telephone, email or face-to-face contact to assist patients with their health care needs. Communicates with clients, support staff and third party payors.
  • Responsible for ensuring external and internal telephone calls are answered in a professional and timely manner in accordance with department policies, procedures and performance goals.
  • Updates patient information within electronic patient management system.
  • Notifies patients of their financial obligation at the time of service for any amount beyond the copay.
  • Same day, walk in, and future insurance appointments are verified for eligibility and benefits.
  • Works closely with health center and call center staff to assist in identification of patient financial responsibility.
  • Helps patients arrange payment for services that are not covered by their insurance companies, discussing different payment options to fit their budgets.
  • Maintains all passwords for the Managed Care/Third Party carriers who allow benefit status via provider websites.
  • Maintains confidentiality of all information; adheres to all HIPAA guidelines/regulations
  • Perform other duties as assigned.

PRIMARY ACCOUNTABILITIES

  • Ensure the accurate and timely collection of medical, behavioral health and dental insurance information.
  • Ensure all insurance verification efforts contribute to a positive patient experience and that all patient inquiries, complaints, and requests for assistance are addressed in a timely and professional manner.
  • Develop and maintain positive working relationships with patients, co-workers, vendors, third party payor resources and related entities. 
  • Maintain up-to-date knowledge of insurance verification processes.
  • Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner at all times.
  • Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.

ESSENTIAL FUNCTIONS/ KEY COMPETENCIES

 

  • High level of skill at building relationships and providing excellent customer service.
  • Ability to utilize computers for data entry, research, and information retrieval.
  • Strong attention to detail and accuracy.
  • Ability to multitask.
  • Excellent verbal and written communication skills.

Qualifications

Education

  • High school diploma or equivalent.

Knowledge and Experience

  • 1 year of medical or health insurance office experience.
  • Demonstrated knowledge of administrative and clerical procedures and systems such as word processing and database systems, filing and records management systems, transcription, and other office procedures and terminology.
  • Solid knowledge of Health insurance processes.
  • Solid knowledge of NextGen EPM.
  • Demonstrated familiarity and experience in the use of computer and commonly used software including but not limited to Microsoft Office Suite.

Physical/ Environmental

  • Constant sitting, standing and walking.
  • Occasional bending, reaching, and lifting.
  • Constant use of a computer.
  • A medium to high level of manual dexterity required.

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