Insurance Verification Specialist
Job Description Summary
The insurance verification specialist is responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider. He is responsible for entering data in an accurate manner, as it is his job to update patient benefit information in the organization’s insurance system and verify that existing information is accurate. This position requires professionals to spend extensive amounts of time on the phone with insurance companies.
Essential Job Functions/Responsibilities
- Verification of Payer source at time of referral.
- Contacts Insurance Company as needed to verify Hospice Benefit.
- Submits Authorization request and makes sure all required documentation is submitted.
- Reviews and submits all follow up Authorizations.
- Excellent communication with Insurance companies is required.
- Document verifications, and authorization information in the internal software.
- Communication with Intake staff to ensure that all referred patients have an identified Payer source and if any documents or information is missing.
- Acts as a resource for both staff and patient/family on Insurance questions.
- Verifies Medi-Cal Eligibility and Benefits every month that patient is on service.
- Reviews the internal software to verify correct information is completed. Including Benefit Periods for Medicare.
- Review Admission documents to make sure we have Consents, NOE, and Transfer Form, if needed.
- Scan all applicable documents into internal software. IE: Eligibility Form, Authorization Request Form.
- Ensure timely processing of benefit information and seek assistance from manager when necessary.
- Contact clinical staff for patient’s clinical information if it is needed by the insurance provider for the authorization.
- Contact Skilled Nursing Facilities to notify them patient is admitting onto Hospice services and verify SOC has been cleared for room and board patients.
- Make phone calls to Insurance Companies to check the status of outstanding claims.
- Work cordially with all staff and participate in meetings, sharing ideas and information.
- Maintains confidentiality of all information; adheres to all HIPAA guidelines/regulations.
- Other duties as assigned.
One to two years prior Hospice Billing and/or Insurance Verification experience