Central Insur Verification Rep

Job description

Position Summary
Position Title: Central Insurance Verification Rep
Department: APAS NSI Administration
Location: Melbourne, FL.
Shift: Pool/PRN
Position Summary
Work as part of a Team which is responsible for Insurance verification for the physician, hospital, or surgery appointments.
Responsibilities
Essential Functions
• Verify insurance plan and network to make sure that the physician office, hospital, or ambulatory surgery center is participating.
• Contacts appropriate payers to verify insurance coverage and benefits.
• Knowledge in the use of understanding electronic verification tools and web based resources.
• Knowledge and familiar with a commercial and state funded insurance plans.
• Must be able to identify an HMO, POS, Open access and/or PPO type plan.
• Verify effective date, group number and claim address.
• Verify copays, deductible amounts, out of pocket amounts and co-insurance.
• Efficiently and accurately input the insurance information on the account for correct billing and proper referral processing.
• Reviews insurance coverage for same day appointments.
• Reviews and works reports for future appointments.
• Rotate with other staff to work reports and immediate attention forms.
• Link patient /guarantor party to the insurance on accounts.
• Communicate with the physician offices to report eligibility issues or obtain updated information to complete verification process.
• Identify and understand coordination of benefits when needed.
• Create alert notes on accounts with information that the offices will need to know.
• When insurance has an assigned PCP listed, note this on the accounts.
• Responsible to make insurance changes to all accounts when applicable.
• Notify Account Receivable to review accounts in question when making insurance changes.
• Must be able to keep up with the daily productivity goal for the department.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions
• Work additional reports to research missing insurance on services that were rendered.
• Assist other team members if needed.
• Work on assigned projects.
• Attends and participates in department staff meetings as assigned.

Qualifications
Education/Training
• High school diploma or equivalent.

Licensure/Certification
• None.

Experience
• None.