Insurance Verification Specialist

AdaptHealth LLC; United States; Remote; USD 22,000 - 33,000; Full time

Job summary

AdaptHealth LLC is seeking an Insurance Verification Specialist to join our team. The role focuses on learning the full front-end process, handling inbound and outbound calls, verifying patient insurance, and ensuring accurate documentation to support timely equipment delivery.

The candidate will work with EMR systems, understand payer requirements, and communicate effectively with Patients and Management. A fast-paced environment and strong attention to detail are essential.

Qualifications

• High School Diploma or equivalent.
• 1 year work experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management.
• Senior level requires two years of work-related experience and one year of exact job experience in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Responsibilities

• Develop and maintain knowledge of products and services offered by the company.
• Review required documentation for accuracy.
• Maintain knowledge of payer coverage and policies.
• Verify patient insurance coverage for procedures.
• Complete insurance verification to determine eligibility, coverage, and deductibles.
• Obtain pre-authorization when required by carrier and process physician orders.
• Resolve coverage issues and escalate to a Manager when needed.
• Enter accurate patient demographics and insurance into EMR databases.

Skills

Analytical thinking

Communication skills

Time management

MS Office

Medicare knowledge

Teamwork

Adaptability

Problem solving

Stress management

Education

High School Diploma or equivalent

Tools

EMR systems

Job description

All Jobs > Insurance Verification Specialist

At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives,

Insurance Verification Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Insurance Verification Specialists works in a fast-paced environment answering inbound calls and making outbound calls. Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor. Insurance Verification Specialists should educate Patients of their financial responsibility when applicable.

Insurance Verification Specialist

Job Duties:

• Develop and maintain working knowledge of current products and services offered by the company.
• Review all required documentation to ensure accuracy.
• Maintains an extensive knowledge of different types of payer coverage and insurance policies.
• Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by the individual’s insurance accurately.
• Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles.
• Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
• Resolves any issues with coverage and escalates complicated issues to a Manager.
• Completes accurate patient demographic and insurance entry into EMR databases.
• Responsible for entering data in an accurate manner, into EMR databases. To include payer, authorization requirements and coverage limitations and expiration dates as needed
• Position requires staff to spend extensive amounts of time on the phone or on payer websites with insurance companies.
• Position requires representative to provide pertinent information regarding patient’s coverage.
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
• Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies.
• Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered.
• Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
• Meet quality assurance requirements and other key performance metrics.
• Facilitate resolution on customer complaints and problem solving.
• Pays attention to detail and has great organizational skills.
• Actively listens to patients and handle stressful situations with compassion and empathy.
• Flexible with the actual work and the hours of operation
• Utilize company provided tools to maintain quality. Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and “How-To” documents

Competency, Skills and Abilities:

• Analytical and problem-solving skills with attention to detail
• Decision Making
• Excellent ability to communicate both verbally and in writing.
• Ability to prioritize and manage multiple tasks.
• Proficient computer skills and knowledge of Microsoft Office
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
• General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
• Work well independently and as part of a group.
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.

Requirements

Minimum Job Qualifications:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.