Insurance Verification Specialist II
Job ID
2023-26283
# Positions
1
Job Location
US-MI
Telecommute
Regional Remote Position
FT/PT
Full-Time
Category
Medical Office Professionals
Why Us?
With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.
Could This Be For You?
Review patient information to ensure insurance coverage is active and contact health insurance companies to verify eligibility and benefits from within an organization that provides healthcare patient services. Work with third-party payers to obtain pre-certification/pre-determination/pre-authorization prior to delivery of scheduled devices and services. Document and maintain accurate registration and benefits information for patients complete and communicate current status of authorizations, claims, and appeals.
Your Impact
Principal Duties and Responsibilities (Essential Functions):
Promote the values of Hanger
Reviews documentation to ensure meets needs of payer and is in alignment with payer medical policy
Verifies diagnosis code on patient billing is accurate and reimbursable
Communicates with clinic staff to obtain necessary documentation
Communicates with insurance companies to verify patient benefits
Submit authorization request to insurance companies and follows up as needed
Determine insurance financial information such as coinsurance, deductible, etc. used to determine patient responsibility
Coordinate with clinic if items are determined to be not covered
Ensures authorizations provided by insurance companies are accurate and contain correct codes, quantities and appropriate authorization date ranges
Updates patient chart with necessary notations, authorization numbers, and documentation
Contact third-party payer to validate patient's coverage
Contact patient for updated insurance information
In the event of a denial of authorization communicate with clinic to determine if the submission of an appeal if appropriate. If appropriate submit the appeal to the payer and follow up as needed.
Perform other duties as assigned
Minimum Qualifications
Experience and Education:
High school diploma or equivalent
Minimum of 2 years of in a medical office or related experience
Preferred
Medical terminology knowledge
Pre-Authorization knowledge/experience
Knowledge of insurance payer requirements
Experience with EMR systems (NextGen and/or OnBase)
Basic computer knowledge
DME/Orthotic knowledge
Additional Success Factors
Knowledge and Skill:
Able to initiate communication with clinic staff and insurance companies
Excellent customer service and communication skills
Able to manage multiple responsibilities and to prioritize duties/tasks in a fast paced working environment
Good interpersonal, oral and written communication skills, including the ability to follow written and verbal directions
Resourceful and flexible team player who excels at building trusting relationships with patients, referral sources and colleagues
Working knowledge of HIPAA and other medical insurance regulations and terminology for private payer, state and federal plans including coding, billing and reimbursement protocols
Working knowledge of ICD-9, ICD-10, HCPC/CPT and other coding
Proficient computer software; such as MS Word, Excel, and automated billing systems
Able to use various type of office equipment; such as, facsimile machines, calculator, postage machine, copiers, etc.
Knowledge of state, federal and regional collection and reimbursement laws
Must have an enthusiastic and positive attitude
Ability to work independently, exercise creativity, and be attentive to detail
Proficiency with basic math and accounting skills
Act with integrity in all ways and at all times, remaining honest, transparent, and respectful in all relationships.
Keep the patient at the center of everything that you do, building lifelong trust.
Foster open collaboration and constructive dialogue with everyone around you.
Continuously innovate new solutions, influencing and responding to change.
Focus on superior outcomes, and calibrate work processes for outstanding results.
Our Investment in You
Employees working at least 20 hours per week... For full info follow application link.
Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The company will comply with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited.
