Insurance Verification Specialist Details

Insurance Verification Specialist

RestorixHealth - Irvine, CA

Employment Type : Full-Time

Insurance Verification Specialist Job Summary: The Insurance Verification Specialist (IVS) is a key component in the Revenue Cycle Management (RCM) process for Gordian Medical. Reporting directly to the Revenue Cycle Management, job functions include responsibility for accurate verification of insurance coverage to ensure a clean billing process. IVS are required to work with colleagues daily, via phone and in person, assisting with coverage, eligibility and benefit verifications and questions. Through this with the RCM and other departments, the goal will involve ensuring the patients provided for are covered through their payer and collection goals will be met. Specific expectations of performance and cut-off times will be met.

What We Offer:

• Monday – Friday schedule, no weekends
• Comprehensive benefits package (Medical, Dental, Vision, Life, 401k)
• Generous paid time off
• Career Pathways to Wound Care and Hyperbaric Certification
• Internal ongoing educational opportunities

Primary Responsibilities:

• Maintain patient demographic information and data collection systems
• Verify insurance eligibility and benefits for commercial payers utilizing online websites and portals or by contacting payer directly
• Work in conjunction with all teams of RCM to ensure clean claims
• Verification of hospice or home health coverage of patients, including communication to the field staff regarding this status as well as communicating with hospice companies
• Collaborate across departments and build effective relationships with internal and external customers to meet deadlines
• Exhibit high level quality level of attention to detail and monitoring of work
• Daily email communication with clinical staff, order fulfilment and management
• Submit daily performance metrics
• Provide excellent customer service for both incoming and outgoing inquires
• Maintain sensitivity to organizational workflow systems outside your immediate department. Understand the impact and implications of decisions and requests affecting other divisions, team and/or individuals within the company
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance

Education and Technical Skills:

• High School Diploma
• Keyboarding/typing skills 50 wpm
• Knowledge of ICD10 codes
• Knowledge of HCPC codes

Additional Eligibility Qualifications/Competencies:

• 1-2 years of experience in a medical/billing environment
• 1-2 years of experience in insurance verification, benefits and pre-authorization.
• Knowledge of health care system, including but not limited to Medicare, Commercial and Medi-cal/Medicaid coverages
• Must have a comprehensive understanding of Deductibles, Coinsurance, Copay, Out of Pocket Maximum, difference between in and out of network benefits and prior authorization requirements.
• Experienced with Durable Medical Equipment/Wound Care
• Basic knowledge in medical terminology
• Detail oriented, a strong communicator, organized and able to multi-task in a fast-paced environment
• Ability to work independently as well as cohesively with other team members
• Knowledge in Office products such as Outlook E-mail, Word and Excel
• Brightree experience
• Excellent organizational skills, ability to problem solve and work as an independent worker
• Good math, computer and keyboarding/typing skills
• Compliance with HIPAA and PHI guidelines

At RestorixHealt-AMTh, we grow talent. When you join our team, you have the opportunity to develop your career based on your strengths and potential, including the possibility to move functionally, geographically, laterally and vertically. This is a career destination for engaged, caring, passionate and talented people who want to make a difference. We are the leader in the development and management of comprehensive wound healing and Amputation Prevention Center facilities.

RestorixHealth-AMT is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender, age, religion, disability, sexual orientation, veteran status or marital status.
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