Medical Insurance Verification Agent

SUMMARY/OBJECTIVE:

Responsible for obtaining insurance eligibility and determining patient coverage/responsibility for Out-Patient Behavioral Health and Medical Services benefits on all types of insurance carriers.

RESPONSIBILITIES/DUTIES:

• Communicates with insurance providers to obtain verification of benefits for patients and generating estimates of patient costs to provide to our Patient Advocates
• Work with patient Advocates to submit completed pre-authorization paperwork to the insurance providers
• Check status of pending claims
• Analyze insurance company requirements and communicate any changes to clinical leaders
• Maintains the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
• Performs related work as required
• Works closely with agency to meet established timelines
• Adhere to all company policies and procedures
• Other assigned duties

JOB SPECIFICATIONS:

• Experience and Knowledge in patient verification and authorization processes
• Experience in calculating benefit usage balances, copay or coinsurance, deductible met/remaining, contract year policy, and annual max benefit, and other health insurance mathematical calculations
• Problem solving experience
• Must be well organized and very detail oriented
• Ability to multitask
• Ability to establish and maintain effective working relationships with all segments of the branch staff, billing and collections department and, insurance representatives
• Proficient with Microsoft Office (Outlook, Work and Excel), Medical Practice
• Self-Starter and able to work independently
• Computer literate and can learn new software programs
• Can use basic office equipment

REQUIRED EDUCATION/EXPERIENCE:

• 2-years Insurance Pre-Authorization experience

ESSENTIAL FUNCTIONS:

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Environment:

The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work)

Physical Demands:

Sedentary-Exerting up to 10 lbs of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects

Frequently: 46-100%

• Stooping, Kneeling, Crouching, Fingering, Grasping, Talking, Hearing, Repetitive Motion, Sitting

Occasionally: 16-45%

• Reaching, Standing, Walking, Pushing, Lifting, Driving

 

Vision

The worker is required to have close visual acuity to perform an activity such as: viewing a computer terminal and extensive reading

 

EEOC Disclosure:

Salience Health is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.