Insurance Authorization & Verification Specialist

The Insurance Verification/Authorization Specialist works under the supervision of the Billing Manager. The primary functions of this position are to obtain patient eligibility information and verify insurance coverage, document eligibilities in the electronic medical record system and/or to process insurance authorization request and inquiries new existing services and other resources in the community, initiate insurance authorizations, assist with and complete data entry, facilitate the referral intake process for patients in all stages of life, facilitate the flow of patient information to/from staff nurses, patients and physicians, and to assist staff with problem solving. Perform other appropriate duties as assigned.

PRIMARY JOB DUTIES

1.0       55%    QUALITY OF WORK:

1.1 45% Obtains new patient eligibility information and verifies/obtains authorization insurance coverage for services as evidenced by:

Obtains patient demographic information, contacts Medicare, Medicaid and/or insurance companies to validate coverage available.

Coordinates with Intake and Facility Liaisons to ensure timely processing of verifications.

Verifies deductibles, co-insurance and co-pays prior to start of care.

Calculates patient estimated co-pay and probable costs.

Communicates costs with patient and clinical staff.

Utilizes insurance verification software to determine benefits including

Blue-E and DDE, etc.

Ensures services are authorized as required by payer source.

Updates deductibles and eligibility information for established patients.

Any other duties as assigned.

1.2       10%   Appropriately communicates information according to agency policies and procedures as evidenced by:

• Facilitates and coordinates communication between agency staff, physicians and patients in a timely and effective manner.
• Takes phone calls from the patient/family as needed to answer questions.  Obtains pertinent facts from the record and patient to appropriately solicit verification/authorizations.

• Facilitates clarification of referral data from physicians and/or referral sources.
• Acts as resource for staff.

2.0       20%    PRODUCTIVITY/USE OF TIME

2.1       10%    Organizes and performs work effectively and efficiently as evidenced by:

• Accepting personal responsibility for the completion and quality of work outcomes.
• Meeting assigned deadlines.
• Meeting productivity expectations for insurance authorizations achieved.

2.2       10%    Maintains and adjusts schedule to enhance team performance as evidenced by:

• Reporting to work on time and returning promptly from errands, breaks and meals.
• Managing personal work schedule and time off to promote smooth agency operations.
• Assisting other team members to ensure completion of all work assignments.
• Demonstrating flexibility with changing workload/assignments.

3.0       20%    TEAMWORK, MISSION, VISION, VALUES

3.1       20%    Demonstrates positive interpersonal relations in dealing with all members of the team (ie: coworkers, supervisors, physicians, etc.) as evidenced by:

• Communicating in a positive and productive manner.
• Demonstrating respect for team members.
• Managing stress and personal feelings without negative impact on the team.

• Participates in community outreach activities that promote goals and objectives of the agency.

4.0       5%      CONFIDENTIALITY

4.1       5%      Maintains confidentiality in all professional areas and considers the needs of clients and their families, other employees, physicians, visitors, and all members of the community in an informative, courteous and compassionate manner.

JOB SPECIFICATIONS