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Insurance Verification Specialist

Pay Range: Min: $19.41 Mid: $25.68. Pay is based upon relevant education and experience. 
 
POSITION PURPOSE: 
Acts as a liaison between patients, providers, and insurance companies to ensure appropriate data collection, compliance with third party payers and federal and state regulations. Obtains benefits, eligibility and preauthorization, and acts as a financial counselor when explaining insurance and payment options.
ESSENTIAL JOB FUNCTIONS: 
  1. Works closely with physician schedulers and the OR Manager to ensure accuracy of the schedule, accuracy of data entry and troubleshoots to obtain any missing information.
  2. Demonstrates a high working knowledge of managed care contracts and major third party payers when verifying insurance benefits, eligibility and prior authorization requirements for scheduled patients.
  3. Notifies patients of estimated liability and acts as a financial counselor regarding insurance and payment options. Ensures compliance with surgery center collections policies.
  4. Screens patients for Financial Assistance Program eligibility. Clearly documents insurance details, required payments and any additional information to assist patient access and collections.
  5. Coordinates with the physician’s office when prior authorization requirements are not in place.
  6. Works closely with other departments to ensure that the process is running as smoothly and efficiently, including timely notification of add-ons and cancellations. Ensures the patient access and clinical staff are aware of any potential insurance related delays.
  7. On an as needed basis will assist and back-up other front office staff positions and may assist with orientation of new hires.
  8. Demonstrates dedication to customer service such as assistance with telephone calls, giving directions, and providing general facility information. Interacts with external and internal parties with courtesy and sensitivity.
  9. Actively participates as a collaborative member of the department team by communicating constructively, identifying business office and interdepartmental problems, and resolving conflicts appropriately.
  10. Responsible for coordinating with other staff members and schedulers when out of the office to ensure insurance activity continues seamlessly.
  11. Role models the principles of a Just Culture and Organizational Values.
  12. Perform other duties as assigned. Must be HIPAA complaint.

 

Tis description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
 
MINIMUM QUALIFICATIONS: 
Experience:
  • One year healthcare experience required or one year of related experience required.
  • Medical terminology and working knowledge of surgical equipment (machines, implants, etc.) helpful.
  • Knowledge of ICD-10 and CPT coding desirable.
License(s):
  • N/A
Certification(s):
  • N/A
Computer / Typing:
  • Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
Must have working knowledge of the English language, including reading, writing, and speaking English.
 
Education:
  • Bachelor’s degree preferred with emphasis in business and/or health sciences.

As a condition of employment, Vail Health requires COVID-19 vaccination of all clinical and non-clinical staff.

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