Insurance Verification Specialist - Sioux Falls, SD

The Insurance Verification Specialist is responsible for obtaining patient demographics, verifying eligibility and benefits and obtaining the appropriate authorization for anticipated procedures. The role requires exceptional customer service skills with the ability to communicate effectively, both verbally and in writing, to patients, internal customers and external customers.

Responsibilities

  • Identify and document all patient accounts accurately based on what type of insurance product the patient has, PPO, HMO, other Managed Care Organizations, Medicare Advantage Plans, Government plans or Workman Compensation policies.
  • Completes accurate and timely insurance verifications.
  • Accurately completes all data entry necessary including patient demographics, insurance information and benefit details.
  • Confirms pre-authorization requirements, submits available medical documentation and documents authorization approvals or denials.
  • Notify all patients of any significant gaps in coverage and/or high co-pays or deductibles prior to services being rendered.
  • Manages inbound calls from patients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.
  • Other duties as assigned.

Requirements

  • At least 2-5 years of medical billing & Insurance verification experience. Orthopedic/Pain management/ Ambulatory Surgery Center billing experience is highly preferred.
  • Proficiency in MS Word and Excel a must
  • Experience with Vision, AdvantX and/ or Zirmed is helpful.
  • Basic level mathematical proficiency, with a strong ability to understand, interpret, calculate and communicate financial responsibility
  • Advanced knowledge of In Network and Out of Network processing.
  • The ability to meet critical deadlines.
  • Sound judgement and strong skills with respect to interpersonal relations, critical thinking, problem solving and analysis.
  • Excellent communication skills.
  • Must possess positive attitude to enhance a cooperative and energetic work environment.
  • Excellent knowledge of health care billing procedures, documentation, regulations, payment cycles and standards.

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