Insurance Verification Representative

ORTHOPEDIC SPECIALISTS OF SW; Fort Myers (FL); On-site; USD 36,000 - 48,000; Full time

Job summary

Orthopedic Specialists of SW Florida is seeking an Insurance Verifications Representative to join the Billing department. This full-time role oversees patient authorizations and verifications of insurance, coverage and benefits, with access to PHI.

Responsibilities include obtaining verifications, coordinating referrals, documenting eligibility, communicating with patients about out-of-pocket costs, and maintaining accurate records in the computer system.

Qualifications

• High School diploma or GED required.
• Associates degree preferred.
• Minimum of 2 years insurance and benefit experience.
• Knowledge of medical insurance and billing.
• Ability to document accounts clearly.
• Computer Literate – Windows environment.
• Knowledge of medical terminology.
• Strong organizational skills.
• Ability to perform basic mathematics.
• Ability to clearly communicate written and verbal instructions.
• Ability to efficiently manage multiple tasks and prioritize.
• Telephone etiquette and computer skills.

Responsibilities

• Receive patient information, calls or accesses website resources in respect to carrier documentation
• Obtain insurance verifications and authorizations from insurance companies via telephone, facsimile or online program
• Obtain and coordinate required patient referrals and insurance authorizations to support timely access to services
• Document eligibility and benefit information on insurance verification form
• Scan authorization and verification of patient’s eligibility and benefits
• Communicate with patients regarding their out-of-pocket expenses for large deductibles, limited benefit plans and out-of-network benefits
• Facilitate payment arrangements when necessary
• Communicate with appropriate staff members regarding problems relating to patient’s eligibility and benefits
• Document all necessary patient information and notes in computer system

Skills

Insurance verifications

Medical billing

HIPAA knowledge

Organizational skills

Telephone etiquette

Education

High School diploma or GED

Associates degree preferred

Tools

Windows OS

Billing software (generic)

Job description

Orthopedic Specialists of SW Florida

Job Title: Insurance Verifications Representative

Department: Billing

Exempt Status: Nonexempt

Position Status (FT/PT/PRN): Full Time

Reports To: Billing Director

Supervises: N/A

Job Summary: Oversee all patient authorizations and related verifications of insurance, procedure eligibility/coverage and patient benefit plan information. This position has unrestricted access to protected health information (PHI) pertaining to all patients.

Essential Functions

• Receive patient information, calls or accesses website resources in respect to carrier documentation
• Obtain insurance verifications and authorizations from insurance companies via telephone, facsimile or online program
• Obtain and coordinate required patient referrals and insurance authorizations to support timely access to services
• Document eligibility and benefit information on insurance verification form
• Scan authorization and verification of patient’s eligibility and benefits
• Communicate with patients regarding their out-of-pocket expenses for large deductibles, limited benefit plans and out-of-network benefits
• Facilitate payment arrangements when necessary
• Communicate with appropriate staff members regarding problems relating to patient’s eligibility and benefits
• Document all necessary patient information and notes in computer system

Core Competences

• Responsible for promoting the Standards of Excellence for Orthopedic Specialists while demonstrating courteous and cooperative behavior toward patients, visitors, volunteers, peers and physicians
• Maintain a neat and orderly work environment, demonstrates the ability to organize and prioritize work during heavy workload situations to expedite patient care
• Maintain strictest confidentiality in accordance with HIPAA compliance
• Perform quality work within deadlines with or without direct supervision
• Work effectively as a team contributor on all assignments
• Work independently while understanding the need to communicate and coordinate work efforts with other employees and organizations

Minimum Requirements (education, experience, special skills and licenses or certifications required) continued

• High School diploma or GED required
• Associates degree preferred.
• Minimum of 2 years insurance and benefit experience
• Ability to perform essential duties
• Knowledge of medical insurance and billing
• Ability to document accounts clearly
• Computer Literate – Windows environment
• Knowledge of medical terminology
• Strong organizational skills
• Ability to perform basic mathematics
• Ability to clearly communicate written and verbal instructions
• Ability to efficiently manage multiple tasks and prioritize
• Ability to demonstrate proper telephone etiquette and computer skills

Essential Physical Functions

• Sitting long periods of time
• Manual dexterity sufficient to operate keyboard, calculator and other office equipment as necessary
• Ability to view computer screens for long periods of time

Equipment Used

• Computer, scanner, printer, calculator, photocopier, facsimile, telephones

Additional Comments

• Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
• The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not intended to be an exhaustive list of responsibilities, duties and skills required of persons so assigned.