RCM - Insurance Verification Specialist

Job Description

Job Description

Position Summary

The Insurance Verification Specialist is responsible for verifying patient insurance coverage and benefits to ensure accurate billing and claims processing. This role involves interacting with patients, clinicians, and insurance companies to obtain and confirm necessary information. The specialist will also manage and update patient insurance information in the system, ensuring compliance with all relevant regulations.

Essential Duties & Functions

• Verify patient insurance coverage and benefits eligibility using the EPIC Real Time Eligibility module.

• Interact with patients, healthcare providers, and insurance companies to obtain necessary information.

• Coordinate with clinical staff and operations to ensure all required documentation for insurance verification is available.

• Update insurance and patient information in the EPIC system as necessary.

• Follow up on any issues related to insurance verification and claim submission.

• Navigate insurance company websites and online tools to confirm details of coverage.

• Resolve patient billing and insurance inquiries and disputes.

• Communicate with patients regarding their insurance coverage and benefits including financial obligations.

• Comply with all privacy and confidentiality rules and regulations.

• Document in record of all interactions for reporting and audits.

• Communicate with Revenue Cycle Management (RCM) Leadership to report trends, issues, and system optimization opportunities.

Required Education, Certifications, Licenses, & Training

• High School Diploma or Equivalent.

• EPIC Certification preferred but not required.

Required Years of Experience

• Minimum of 1 year of experience in insurance verification with FQHC experience preferred but not required.

Required Knowledge, Skills, and/or Abilities

• Proven work experience as an Insurance Verification Specialist or similar role in healthcare setting.

• Excellent understanding of insurance benefits and eligibility, medical terminology, and coding specific to Ins. Verification.

• Proficiency in Real Time Eligibility and payer portal navigation.

• Ability to work independently and manage time effectively to achieve daily productivity measures.

• Excellent verbal and written communication skills.

• High level of accuracy and attention to detail.