Insurance Verification Specialist

Job DescriptionSummary: Handles insurance verification and benefits, pre-certification/pre-determination process, referrals, prepares medical records, assist front desk with insurance and precertification related questions. Duties and Responsibilities include the following: 1. Verifies Benefits and Eligibility. 2. Locates a list of patients that need insurance to be checked. 3. Works with report management system. 4. Checks benefits through InstaMed, Navinet, MassHealth or any other website that check benefits and eligibility. 5. Uses the organization s EMR system proficiently. 6. Attaches InstaMed/or other company s results into Greenway EMR. 7. Updates insurance lists from the master list. 8. Updates participating physician s list. 9. Register patients in Greenway system. 10. Completes INSVER task and creates new tasks in the EMR system. 11. Calls insurance companies for detailed benefits and obtains detailed benefit reports when necessary. 12. Verifies and fills out all necessary Benefits and Eligibility forms, extended info, etc. 13. Uses Insurance Manual to complete all required reports (Insurance Manual is provided). 14. Adds Alerts and appointment Quick Text notes. 15. Runs Eligibility Report on daily basis for 2 week ahead. 16. Uses EMR s Eligibility tool to see if insurance is active. 17. Performs Pre-certification process. 18. Reviews insurance requirements table that lists all states, all insurance, all procedure requirements. 19. Initiates pre-certification/pre-determination case: call, email, fax, or mail. 20. Completes Precert2 task, and starts Precert3 task. 18. Gets status on every Precertification case, use Precert dialer that is triggered by open Precert3 tasks. 21. Uses Open Precert Task report and sorts out by Precert-3 task. 22. Calls all insurances for patients whose procedure appointments are scheduled in the following four days. 23. Follows the routine protocol of further task creation for all departments in case of approval or denial. 24. Calls PCP offices to obtain HMO/PCP referrals. 25. Uses Excel proficiently. 26. If HMO REF not obtained, complete AUTCAL task and call again tomorrow 27. When attaching REF into Vitera Images use format: MD name, # of visits, date range of REF 28. Prepares Medical records if requested. 29. Make calls to insurance using Precert Dialer: Performs light clerical duties, including copying, faxing and filing.* Demonstrates knowledge of services, professionalism and outstanding customer service.* Handles multi-line and multi-language telephone calls.* Demonstrates knowledge of services, professionalism and outstanding customer service.* Adheres to established procedures for inter-office communication and other guidelines related to the job and the company.* Performs light office maintenance. Takes part in chat and email communication with patients and other clients. Performs other related duties as assigned. Company DescriptionUSA Vein Clinics is a leading national medical services provider specializing in the treatment of venous insufficiency. Headquartered in Northbrook, IL, our 50 treatment centers comprise the national only coast-to-coast phlebology practice. Our award-winning medical staff, including cardiovascular surgeons, interventional radiologists and cardiologists, provide state-of-the-art patient care using innovative technology. We provide a challenging and dynamic work environment, many opportunities for advancement, and competitive compensation and benefits. Consider joining our fast-growing team to take your career to the next level!