Verification of Benefits Specialist

VIVA USA Inc; Florida; Presencial; USD 25.000 - 39.000; Jornada completa

Descripción de la vacante

VIVA USA Inc. is seeking a Verification of Benefits Specialist on-site in Florida to verify patient insurance benefits, initiate authorizations, and obtain PCP referrals as needed.

You will file appeals for denials and maintain accurate records in the practice management system, coordinating with multiple departments to ensure timely outcomes. The role requires prior authorization/verification experience, strong communication skills, and the ability to work under pressure to meet deadlines.

Formación

• Must have prior authorization/verification experience.
• High school diploma or GED required.
• Minimum 1 year experience in insurance benefits verification and/or collections and/or managed care contracting.
• Excellent verbal and written communication skills.
• Ability to work under pressure and meet deadlines with positive attitude.
• Understanding Medicare rules and managed care as relates to authorizations.

Responsabilidades

• Verify insurance benefits with insurance companies.
• Initiate pre-authorization, PCP referral and Letter of Agreement requests and follow up.
• File appeals for denied coverage as needed.
• Maintain records in the practice management system related to benefits and authorizations.
• Coordinate with other departments to complete verifications and outcomes.
• Provide updates on authorization status, financial responsibility estimates, and collect co-pays when applicable.
• Apply company procedures and update records according to outcomes.
• Perform other related duties as assigned.

Conocimientos

Verifications of benefits

Customer service

Verbal & written communication

Independent work

MS Office

Educación

High school diploma or GED

Associate's degree preferred

Herramientas

Practice management system

MS Excel

Descripción del empleo

As the Verification of Benefits Specialist, you'll have the chance to assist our patients in having accurate insurance information on file and collecting authorizations or PCP referrals as needed.

Principle Responsibilities

• Contacts insurance companies to verify insurance benefits.
• Initiates Pre-authorization, PCP referral and Letter of Agreement requests for new and ongoing services with insurance companies and performs follow up activities for an outcome.
• Files Appeals for denied coverage to insurance companies as needed.
• Maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance companies.
• Coordinates and communicates with other departments as needed to obtain necessary information to complete benefit verification, authorization, appeals and outcomes for services of care.
• Provides customers with information that includes but is not limited to: updates on status of authorizations, developing & communicating patient financial responsibility estimates, and collecting co-pays, if applicable.
• Applies knowledge of company procedures, contracted and non-contracted guidelines to process cases accordingly and to respond to incoming correspondence and documentation as well as updating customer records according to outcomes.
• Performs other related duties as assigned.

Must have prior authorization/verification experience.

Required Qualifications

• High school diploma or GED required
• Preferred two or more years' experience, but a minimum of 1 years' experience is required in insurance benefits verification and/or collections and/or managed care contracting.
• Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices
• Understand the process for verification of benefits or collections as it relates to the policies and procedures for effective placement of medical services.
• Complete Understanding of Medicare Rules and Regulations
• Understanding of Managed Care as it relates to benefits and authorizations
• Advanced MS Office experience, with an emphasis on MS Excel desired
• Continued Self Improvement courses & seminars related to position along with "In House" programs provided by the client.
• Must be able to work under pressure and meet deadlines

Preferred Qualifications

• Associate's degree Preferred
• Knowledge in Medical Insurance
• Knowledge in Contracting and Fee Schedules
• Strong Computer/Software Skills

Physical Requirements

• Must be able to work at a computer workstation for extended periods of time

Notes

• 100% onsite.
• Days/Hours: Mon - Friday 8:00am to 5:00pm

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status