RCM, Insurance Verification Specialist

Essential Duties and Requirement Details

• Verify patient insurance coverage and benefits eligibility using the EPIC Real Time Eligibility module.
• Interact with patients, healthcare providers, and insurance companies to obtain necessary information.
• Cook with clinical staff and operations to ensure all required documentation for insurance verification is available.
• Update insurance and patient information in the EPIC system as necessary.
• Follow up on any issues related to insurance verification and claim submission.
• Navigate insurance company websites and online tools to confirm details of coverage.
• Resolve patient billing and insurance inquiries and disputes.
• Communicate with patients regarding their insurance coverage and benefits including financial obligations.
• Comply with all privacy and confidentiality rules and regulations.
• Document in record of all interactions for reporting and audits.
• Communicate with Revenue Cycle Management (RCM) Leadership to report trends, issues, and system optimization opportunities.

Required Education, Certifications, Licenses, & Training (minimum requirements)

• A High School Diploma or Equivalent.
• EPIC Certification preferred but not required.

Required Years of Experience (minimum requirements)

• Minimum of 1 year of experience in insurance verification with FQHC experience preferred but not required.

Required Knowledge, Skills, and/or Abilities

• Proven work experience as an Insurance Verification Specialist or similar role in healthcare setting.
• Excellent understanding of insurance benefits and eligibility, medical terminology, and coding specific to Ins. Verification.
• Proficiency in Real Time Eligibility and payer portal navigation.
• Ability to work independently and manage time effectively to achieve daily productivity measures.
• Excellent verbal and written communication skills.
• High level of accuracy and attention to detail.

Physical & Mental Demands (Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position)

• Frequently required to sit; occasionally required to stand and walk.
• Frequently required to talk and/or communicate both expressively & receptively.
• Occasionally required to lift and/or move up to 25 pounds.
• Occasionally required to bend, twist, climb, and reach.
• Moderate concentration/intensity, which includes prolonged mental effort with limited opportunity for breaks.
• Moderate level of complexity for decision making.

Work Environment

• This position is 100% remote, with occasional in-office attendance as required.
• May be exposed to infectious waste, diseases, conditions, etc., including viruses.
• The noise level in the work environment is usually moderate to loud.
• May work in open areas at times and exposed to various distractions.

Organizational Competencies

• Respectful and Courteous to Others.
• Upholds Confidentiality of All Sensitive Data.
• Values Cultural Differences.
• Responsive.
• Clear and Effective Communication.
• Teamwork and Adaptability.