RCM INSURANCE VERIFICATION SPECIALIST performs clerical functions for patient billing, including verification of insurance information and resolution of problems to ensure a clean billing process. Follows up on accounts that require further evaluation. Works with others in a team environment.
Essential Functions
Maintains patient demographic information and verifies, enters or updates insurance information for new patients and existing patients to include copays and deductibles
Verify insurance eligibility for upcoming appointments by utilizing EMR, online websites or by contacting the carriers directly.
Explain financial responsibilities to patients.
Coordinate with staff and management regarding scheduling errors. Update the error spreadsheet daily.
Enter insurance effective dates and/or authorization details.
Participates in development of organization procedures and update of forms and manuals.
Answers questions from patients, clerical staff and insurance companies.
Works in conjunction with the reception to ensure clean billing.
Performs miscellaneous job-related duties as assigned.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Assists in development and communication of SOP for key areas to improve accuracy and understanding of processes.
Process
Check assigned locations daily and confirm eligibility, copay, and outstanding balance for every scheduled patient.
Enter and update carrier details in the insurance section of the patient account to include plan name, effective dates, co-pays and deductibles.
Flag and address potential errors. All errors should be logged onto the Eligibility Error Spreadsheet
Add copay and outstanding collection notes in the appointment details for the PSR to see and address during the check in process.
If further action is needed, due to portal downtime or insurance errors, enter notes into the appointment details for the PSR to see.
Maintain regular verification management at least two days ahead of schedule
Attempt to collect outstanding balances and/or work with RCM management to assist with questions
Qualifications
Minimum of 1 year working in a medical office.
Medical Billing experience preferred.
Must be comfortable asking for payment.
Must have outstanding phone etiquette and attention to detail.
Benefits
Medical, Dental, Vision Coverage
Life Insurance
Paid Time Off
Long Term Disability
401K Plan
Job Type: Full-time
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Hospitals and Health Care
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