Insurance Verification Specialist

Overview:

The Insurance Verification Specialist I (IVS I) will obtain, clarify, and confirm outpatient benefits, ensuring maximum and prompt payment of services rendered by the referral source and KKI triage staff. This professional will provide excellent customer service to patients/families, health insurance representatives, internal/external providers, clinics, and other Institute staff.

Responsibilities:

1. Verifies insurance coverage and benefits utilizing all available verification and eligibility tools and calls payers when needed. Documents all ascertained information into the registration system.
2. Verifies and/or obtains the necessary referral, authorization, or pre-certification prior to services being provided as required by the payer.
3. Obtains the patient’s information to facilitate the verification of the unique patient identifiers for clinical purposes, billing and collections process, and compliance with state and federal regulatory requirements.
4. Estimate self-pay portions after benefits have been determined (deductibles, co-pays, non-covered services).
5. Documents and follows up on efforts to promote team and clinic awareness.
6. Collects up-to-date demographic information from patients and families.
7. Maintains regular communication and follow-up with patients, families, as well as KKI programs/departments, to include: team leaders, Patient Accounting, Finance, etc. Keeps all applicable parties informed of pending referrals, authorizations, unanticipated delays, and/or other potential issues.
8. Forwards supporting documentation in a timely manner to Care Centers, Patient Accounting, and clinical areas where applicable.
9. Maintains browser and all IAMS Error Logs in a timely and accurate manner.
10. Responsible for the accurate, complete, and timely capture and data entry of patients’ demographic, financial, and clinical information into the various information systems including pre-registration and/or scanning information systems.

Qualifications:

EDUCATION:

• High School diploma or GED required.
• Associates degree desirable.

EXPERIENCE:

• 1 year of related experience with insurance benefit verification in a healthcare setting required.
• 2-3 years EPIC experience preferred.