POSITION SUMMARY

Under the direct supervision of the Patient Access Manager, the Verification Specialist assist the department in the verification of insurance benefits, service utilization reviews for patients, and daily chart auditing/quality improvement for client documentation.

POSITION SPECIFIC DUTIES & RESPONSIBILITIES

• Verifies insurance for Medical, Behavioral Health and Dental encounters. Gives feed back to front desk receptionist when errors have been found.
• Interface with Revenue Cycle Department aka billing and collections to identify and assist with clean claim processing.
• Interface directly with phone operations, aka Call Center (internal or external) to ensure adherence to CDHC Policies and Procedures and excellent patient care.
• Interface directly with Registration and Intake, aka Front Desk to ensure adherence to CDHC Policies and Procedures and excellent patient care.
• Keeps up to date on government requirements and insurance changes.
• Reviews errors and procedural changes in order to maintain appropriate skill level and knowledge required to perform all tasks
• Interfaces with managed care organizations, external reviewers and other third party payors as determined to monitor patient coverage and benefits
• Provide leadership and management of special projects, as assigned.
• Other duties, as assigned.

POSITION REQUIREMENTS

• Education: High School Diploma; GED equivalent with aptitude in math, office/ clerical skills and computer applications
• Experience: 1 or more years in customer service emphasis in ambulatory health care setting
• Preferred 1 year experience in insurance verification

• Expertise: Knowledge of medical terminology
• Language: English fluency
• Work Hours: Monday through Friday, day hours
• Travel: None
• Exposure: The exposure characteristics described here are representative of those an employee encounters while performing the essential functions of this position. For example, while performing the essential functions of this job, the employee seldom is exposed to fumes or airborne particles and toxic or caustic chemicals. Additionally, the employee may occasionally be exposed to blood borne and other hazardous chemicals. Finally, the noise level in the work environment can seldom be quite loud. In all cases personal protective equipment will be provided to the employee in combination with adequate ventilation and other engineering controls to minimize the risk of exposure or other hazardous occurrence
• Physical: Reasonable accommodation may be made to enable individuals with special challenges to perform these essential functions.