Benefits Ver Specialist

Toa; Clarksville (TN); On-site; USD 35,000 - 48,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Paid Time Off

401(k) match

Job summary

Tennessee Orthopaedic Alliance is seeking an Insurance Verification Specialist to ensure timely verification of patient benefits across our Middle Tennessee locations. The role involves using the Workflow Daily Appointment Report to confirm coverage compatibility with TOA plans and contacting patients and providers to obtain necessary information.

Candidates should have 2–4 years in insurance verification, strong attention to detail, and the ability to differentiate plan components like copays

Qualifications

• High school diploma required.
• 2-4 years of experience in insurance verification preferred.
• Must read and understand payer eligibility electronic returns and differentiate between plans, copay, deductible, and coinsurance.
• Requires accuracy, attention to detail, and strong organizational skills.

Responsibilities

• Verifies insurance benefits using the site’s daily workflow reports.
• Follows VOI training procedures for routine tasks and updates records as needed.
• Calls patients, families, providers, and facilities to obtain necessary information for verification.
• Resolves coverage, referrals, precertifications, and escalates complex issues to management.
• Ensures correct data entry in insurance fields and updates as necessary.

Skills

Insurance verification

Attention to detail

Communication

Phone calls

Education

High school diploma

Tools

VOI Training/Procedure Manual

Job description

Tennessee Orthopaedic Alliance is the largest orthopaedic surgery group in Nashville and Middle Tennessee. TOA concentrates on the diagnosis and treatment of disorders and injuries of the musculoskeletal system which allow our patients to live their best life. Ninety plus years later we are advancing the practice of orthopaedic surgery throughout the state.

There are a number of reasons why TOA is an employer of choice; here are a few of them:

• Stability- TOA has been in Middle Tennessee since 1926 and has expanded to over 20 locations!
• Impact- TOA’s team members use our careers – whether in our clinics or our business office – to make a positive difference in the community by building relationships and helping patients live their best life.
• Work Environment- The TOA team focuses on fostering an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
• Total Rewards- TOA offers competitive salaries based on the current Middle Tennessee wage market, plus a comprehensive suite of benefits, including Medical, Dental, Paid Time Off, and more. Our 401(k) plan provides a company match, safe harbor match and profit sharing match to go along with your contributions.

The Insurance 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 elevate 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.

Job Requirements

• High school diploma required
• 2-4 years of experience in insurance verification preferred
• Must have experience reading and understanding payer eligibility electronic returns, and the ability to differentiate between insurance plans, copay, deductible, and coinsurance
• Requires accuracy, attention to detail, ability to follow directions, and organization skills

**TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers**

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.