Patient Coverage Verification Specialist

Major Duties And Responsibilities

• Communicate clearly and effectively with staff of the care team or insurances to ensure timely follow-up and communication.
• Reach out to patients who may need to revalidate their sliding scales and communicate this to the eligibility specialist team.
• Provide prompts, efficient, and personalized assistance to meet the requirements, requests, and coverage needs of patients.
• Identify patient coverage needs and issues and work to resolve them prior to the arrival of the patient for their appointment.
• Explain basic insurance terminology and procedures related to the patient obtaining care from the providers.
• Create and maintain a patient-centric atmosphere of warmth, personal interest, and positive emphasis, as well as a calm environment.
• Handle telephone and written inquiries, enter information into Patient Management System and EMR, and ensure all documentation is appropriately signed and dated.
• Carry out various quality assurance activities, such as collecting client feedback regarding problems with insurance reimbursement.
• Absorb and maintain knowledge of insurance information as it relates to provider credentials.
• Verify eligibility, coverage, and benefits for all scheduled patients.
• Determine any copays/coinsurance/deductible amounts that are patient responsibility and make a note in the appointment comment for the Patient Service Representative to collect.
• Stay 3 days ahead of verifying coverage for appointments.
• Ensure Medicaid is verified at the beginning of every month and work to get caught back up to the 2-day window of coverage verification.
• Arrange treatment authorizations from payers when needed for payment, track authorizations, and notify providers when a new authorization is needed (if applicable to payer).
• Detect and correct errors, complete forms, obtain needed information, and maintain logs and files.
• Maintain open relationships and lines of communication with co-workers and present ideas and suggestions when opportunities for improvement present themselves.
• Work closely with care team and providers to process any prior authorizations.
• Confirm patient insurance coverage prior to initial appointment and document benefits for all new insurances in Practice Management System.

Skills And Abilities

• Excellent interpersonal skills
• Knowledge of medical terminology preferred
• Basic understanding of HIPAA and PHI
• Basic navigational knowledge of electronic medical record applications such as CPS12
• Good time management skills, organized, self-motivated
• Excellent written and verbal communication skills
• Maintain a high level of productivity and confidentiality
• Work well in a team environment
• Ability to enter data with ability to check accuracy of detail work such as correct spelling of names, numbers, dates, and times
• Able to handle multiple tasks at once without mistakes or diminution of professional demeanor and customer service
• Effectively able to prioritize and maintain workflow
• Ability to function in a high volume, multiple task environments, possibly in a closely shared workspace
• Self-motivated and able to work with a high degree of independence
• Strong organizational and task prioritization skills

Education And/Or Experience Required

• High school, G.E.D., or equivalent
• One year of customer service experience and coverage verification experience

Desired

• Experience with Electronic Medical Records Systems
• Bilingual