The Benefit Verification Specialist is responsible for the timely verification of medical insurance benefits. Day-to-day activities may include all or some of the essential functions listed below depending upon individual experience / knowledge and the needs of the organization which are subject to change from time to time.
Utilizes the Workflow Daily Appointment Report for your site as a primary source for insurance verification and determining insurance compatibility with TOA’s managed care plans.
Adhere to best practices standards in performing day-to-day follow-up tasks.This includes following procedures outlined in the “VOI Training/Procedure Manual”.
Place phone calls to patients, patient’s family/significant other, insurance companies, and facility personnel in an attempt to acquire information necessary to verify.
Responsible to resolves any issues with coverage, referrals, precertification and escalate complicated issues to the immediate manager.Also must have a basic knowledge and understanding of what a referral and an authorization are.
Enters and ensures information in the insurance fields is correct to its entirety.If incorrect, information in the system must be updated appropriately. This includes moving any VOB’S, authorizations and clinical referrals.If encounters were billed incorrectly to a now corrected insurance, you must email COLLECTIONS so claims can be rebilled if needed.
Familiar with a variety of the facility concepts, practices, and procedures. Relies on experience and judgment to plan and accomplish goals.
High school diploma required
2-4 years of experience in insurance verification preferable.
QUALIFICATIONS AND EXPERIENCE:
Must have experience reading and understanding payer eligibility electronic returns.Includes the ability to differentiate between insurance plans, copay, deductible, and coinsurance (patient responsibility).
Must be able to meet average expectations for daily site verifications.
Requires accuracy, attention to detail, ability to follow directions, organize and prioritize day-to-day tasks in order to keep work flow current.