Insurance Verifier

Summary Works directly with clinics to identify and secure payer referral requirements for maximum reimbursement

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Work requests from a queue or email communication from clinic staff or other source
• Confirm validity of any referrals already on file
• Submit request for needed referrals to appropriate authority or PCP
• Follow up to secure authorization prior to patient appointment to ensure reimbursement
• Provide requested clinical information to PCP to support referral
• Advise clinic staff of any anticipated delays for authorization
• Secure referrals and enter them in the patient’s electronic record

Education and/or Experience

• Strong, working knowledge of insurance payers to include government, commercial and managed care products
• Ability to establish a good rapport with outside providers and third party payers
• Resourceful, steadfast attitude to make sure that patient needs are met timely
• Comfortable with navigating through the payer websites to secure appropriate benefits and authorization requirements
• Excellent verbal and oral communication skills
• Excellent customer service skills are expected with internal and external customers

Other Qualifications:

• Must be able to multitask and demonstrate excellent organizational skills
• Understanding of insurance contracts and networks essential
• Extensive coding and medical terminology preferred
• Computer literate, knowledge of, or ability to learn multiple clinic/hospital software required.

Education and/or Experience

• Strong, working knowledge of insurance payers to include government, commercial and managed care products
• Ability to establish a good rapport with outside providers and third party payers
• Resourceful, steadfast attitude to make sure that patient needs are met timely
• Comfortable with navigating through the payer websites to secure appropriate benefits and authorization requirements
• Excellent verbal and oral communication skills
• Excellent customer service skills are expected with internal and external customers

Other Qualifications:

• Must be able to multitask and demonstrate excellent organizational skills
• Understanding of insurance contracts and networks essential
• Extensive coding and medical terminology preferred
• Computer literate, knowledge of, or ability to learn multiple clinic/hospital software required.