Job Title: Insurance Verification Specialist 1

The Insurance Verification Specialist 1, under general supervision, provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. This directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts.

Essential Functions of the Role:

• Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed on time.
• Completes appropriate payor forms related to notification and authorization.
• Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
• Calculates accurate patient financial responsibility.
• Communicates promptly with Utilization Review. Collaborates effectively with the physician and facility staff. Ensures financial clearance of the patient's account before any service during the hospital stay.
• Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.

Key Success Factors:

• 1 year of healthcare or customer service experience preferred.
• Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
• Ability to understand and adhere to payer guidelines by plan and service type.
• Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
• Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, including life or death situations.
• Must exhibit high empathy and communicate well with patients and families during traumatic events. Demonstrate exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills. Basic computer skills and Microsoft Office.

Qualifications:

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - Less than 1 Year of Experience