Verification of Benefits Specialist

Principle Responsibilities

• Contacts insurance companies to verify insurance benefits.
• Initiates Pre-authorization, PCP referral, and Letter of Agreement requests for new and ongoing services with insurance companies and performs follow up activities for an outcome.
• Maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes, and communication with insurance company.
• Captures and communicates patient financial responsibility estimates, collects co-pays, if applicable.
• Applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes.
• Performs other related duties as assigned.

Required Qualifications

• A high school diploma or GED.
• Two or more years experience, but a minimum of 1 year experience is required in insurance benefits verification and/or collections and/or managed care contracting.
• Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.
• Understand the process for verification of benefits or collections as it relates to the policies and procedures for effective placement of medical services.
• Complete Understanding of Medicare Rules and Regulations.
• Understanding of Managed Care as it relates to benefits and authorizations.
• Advanced MS Office experience, with an emphasis on MS Excel desired.
• Continued Self Improvement courses & seminars related to position along with In House programs provided by Acelis Connected Health/company.

Preferred Qualifications

• A college degree preferred.
• Knowledge in Medical Insurance.
• Knowledge in Contracting and Fee Schedules.
• Strong Computer/Software Skills.