VERIFICATION SPECIALIST

Job Description

Job Description

POSITION FUNCTION/OVERVIEW:

This position is responsible for the timely verification of medical insurance benefits, calling private insurance companies, Medicare, and/or Medicaid to obtain benefit information, determining insurance compatibility with healthcare provider programs, updating and refiling claims, coordinating with patients regarding their insurance benefits and medical providers programs, re-verifying existing patient insurance coverage, and determining if an insurance benefit plan considers selected products appropriate based on patient need.

PRIMARY DUTIES/RESPONSIBILITIES:

● Promote the mission, values, vision, and philosophy of organization.

● Provide excellent customer service for clients; practices confidentiality and privacy protocols in accordance HIPAA requirements.

● Research plans and provides the admissions team with information about pre-certification, pre-authorization, claims, and policy details.

● Builds positive relationships with both insurance and third party providers

● Appropriately and accurately document details of the verification in CRM in a timely manner.

● Responsible to track, document, and report insurance verification trends for quality assurance.

● Alerts Supervisor of any specific problems, issues, or changes that may affect the admission, authorization, pre-certification, claims, or billing process.

● Maintain a timely and efficient process for verifications start to finish.

● Work with Utilization Review Specialists to achieve the highest levels of care for the client.

● Ensure all required insurance standards and regulations are met.

● Accepts and utilizes supervision.

● Addresses problems noted by supervisor.

● Demonstrates willingness to accept responsibility.

● Function well as a member of the team and contributes positively to the morale of staff.

● Performs other duties as required.

QUALIFICATIONS REQUIRED:

● High School Diploma or GED equivalent with combination of education and work experience, required; Bachelor’s degree, preferred.

● Minimum of two (2) years’ experience in Medical Billing, Coding and Collections.

● Knowledge of Third Party payers, billing requirements and reimbursement methods; knowledge of medical terminology.

● Knowledgeable in the field of Substance Abuse treatment.

● Relevant computer software and hardware applications proficiency – Word, Excel, PowerPoint, Outlook, Electronic Medical Records, Billing Systems and/or other scheduling applications; KIPU preferred.

● CPR/1st Aid/Aggression Control.

SKILLS:

● Strong communication skills, both written and verbal.

● Ability to work independently, as well as part of a team.

● Manage multiple tasks and set priorities.

● Ability to handle highly sensitive and confidential information.

● Ability to work in a fast-paced, high-energy environment.

● Excellent interpersonal and customer-facing skills.

● Ability to work accurately, with attention to detail.

This list of essential functions is not intended to be exhaustive. Mandala Healing Center reserves the right to revise this job description as needed to comply with actual job requirements.