Insurance Liaison

Community Health Net; Erie (Erie County); On-site; USD 42,000 - 62,000; Full time

Job summary

Community Health Net in Erie, PA seeks an Insurance Liaison to support the FQHC network by verifying patient coverage, coordinating with providers and ensuring accurate billing. You will verify eligibility, update records, and work with billing staff to submit claims accurately.

The role emphasizes effective communication with insurers and patients alike.

Qualifications

• High school diploma or GED is required.
• Minimum three years in medical/dental coding or knowledge of medical terminology.
• Experience in a medical or dental office setting is preferred.
• Strong Excel skills and ability to communicate clearly in writing and speech.

Responsibilities

• Verify patients' insurance coverage and eligibility.
• Collaborate with patients to obtain necessary insurance information.
• Update and maintain accurate insurance records.
• Work with billing and coding staff to ensure accurate claims submission.
• Review claims for completeness and accuracy before submission.
• Address insurance-related issues during the billing process.
• Establish and maintain relationships with insurance company representatives.
• Educate patients about insurance coverage and benefits.
• Investigate and resolve claim denials and rejections.
• Maintain confidentiality and HIPAA compliance.
• Perform other duties as assigned by Controller.

Skills

Excel

Communication

Teamwork

HIPAA compliance

Education

High school diploma or GED

Tools

Google Workspace

Job description

Summary

Under the direction of the Controller, the Insurance Liaison plays a crucial role in fostering communication and collaboration between the Federally Qualified Health Center (FQHC) and various insurance providers. This position is responsible for managing insurance-related processes, verifying patient coverage, and ensuring accurate billing and reimbursement.

Essential Duties and Responsibilities

Insurance Verification

• Verify patients’ insurance coverage and eligibility.
• Collaborate with patients to obtain necessary insurance information.
• Update and maintain accurate insurance records.

Billing and Coding

• Work closely with billing and coding staff to ensure accurate claims submission.
• Review claims for completeness and accuracy before submission.
• Address any insurance-related issues emerging during the billing process.

Communication with Insurance Providers

• Establish and maintain strong relationships with insurance company representatives.
• Regularly communicate with insurance representatives accordingly.
• Stay informed about changes in insurance policies and procedures.

Patient Education

• Provide patients with information regarding their insurance coverage and benefits.
• Assist patients in understanding and navigating the insurance process.
• Address patient inquiries related to insurance matters.

Claims Resolution

• Investigate and resolve insurance-related claim denials and/or rejections by means of the worklog.
• Work proactively to prevent claim denials through accurate documentation and communication.

• Maintains all passwords for the Managed Care/Third Party carriers who allow verification via provider websites.
• Maintains confidentiality of all information/adheres to all HIPPA guidelines/regulations.
• Responsible for ensuring external and internal telephone calls are answered in a professional and timely manner in accordance with department policies, procedures, and performance goals.
• Perform other duties that may be assigned by Controller.

Requirements/Qualifications

• High school diploma or General Education Degree (GED)
• Preferred minimum of three (3) years’ experience in one or more of the following: Medical/ Dental Coding Certification and/or knowledge of Current Medical Terminology (CMT), Current Dental Terminology (CDT)
• Relevant work experience in a medical or dental office setting.
• Higher level knowledge of Excel
• Ability to effectively communicate both verbally and in writing. Additionally, establish and maintain effective working relationships with employees, departments, and the public.
• Ability to work independently and with a team to obtain objectives.
• Proficient in office productivity tools such as Google, email, scanner, etc.