INSURANCE VERIFICATION REPRESENTATIVE

JOB SUMMARY

The Insurance Verification Representative (IVR) is responsible for assisting all Client Service Specialists in processing insurance eligibility for all Care Resource patients, including Medical, Behavioral Health and Dental prior to scheduling appointments. Furthermore, the IVR conducts a thorough verification of all appointments on the providers' schedule two day prior to the Date of Service (DOS). The IVR informs patients of any financial obligations, prior authorization, and/or required referrals, before the visit. He/she responds to all internal and external phone calls regarding insurance verification inquiries, including commercial, governmental, and Ryan White.

JOB RESPONSIBILITIES

Patient/Client Services

Verifies all Commercial insurances, Medicare, Medicaid, and Ryan White for eligibility and benefits for future scheduled appointments, as well as, same day and walk-ins whenever applicable and based on need. The representative will create an account on all insurances portals to retrieve updated information about the patient. If the client detains a commercial plan, it is the clerk's responsibility to verify if a Medicaid/Medicare coverage is active by exploring their website.

The clerk ensures to follow the different steps of Care Resource Insurance Verification process, which is detailed as follows:

1.PCP assignation

Ensures that patients are seeing the provider that the insurance assigned to them.

• Patient Credit

Verifies alerts on NextGen indicating patients' credit and document the chart note accordingly.

• Update the patient insurance tab when necessary

Ensures that payer names, Member ID numbers, Effective and termination dates are accurate, the PCP name is posted as well as the Out-of-Network PCP name. The clerk will also include the PCP and Specialist copay.

• Clean the payer list

The clerk is responsible for cleaning the payer list activating only the active insurances.

• Document the chart notes building history

The Insurance Verification Representative (IVR) documents all recommendations or actions taken in the patient's chart notes, enabling the next person who access the chart to understand the previous encounters the client had with our organization.

Resolves routine general questions and/or issues/concerns presented by patients and customers via phone and related to insurance eligibility and referrals requirements.

Works closely with direct client contact services departments, as well as, with other team members in the Client Engagement Services Department, to assist in identifying patient financial responsibility.

Provides accurate information by identifying and alerting appropriate front desk support staff about patients' financial responsibility, to effectively collect owed money at the time of check in, including past due balances.

Answers the telephone promptly, in a courteous and professional manner according to Health Center guidelines to address any issues from patients/clients on the queue.

Models Company culture of service standards in customer service, by providing gracious and efficient service with a sense of commitment, compassion, and competency to all our patients, as well as, to internal/external clients.

Develops and maintains knowledge of all services offered and resources available at the health center.

Retrieves and responds all voice messages in a timely manner (within 24 hours).

He/she will also enter tasks and will access the patient portal to email questions/requests and solutions within the same time frame.

Uses computer systems to log and track inquiries, as well as, to monitor the status of pending items in need of follow-up and/or further intervention additional parties.

Accounts and properly documents all customer/payer interactions, including records details, complaints, comments, and actions taken.

Helps with special projects as needed.

Complies with HIPAA rules and regulations when communicating with patients, clients, health center personnel, and external vendors and payers.

Safety

Ensures proper hand washing according to Centers for Disease Control and Prevention guidelines.

Understands and appropriately acts upon assigned role in Emergency Code System.

Understands and performs assigned role in health center's Continuity of Operations Plan (COOP).

Culture of Service: 3 C's

Compassion

Greets internal or external customer (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language

Listens to internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring an understanding of the request and providing appropriate options or resolutions

Competency

Provides services required by following established protocols and when needed, procures additional help to answer questions to ensure appropriate services are delivered.

Commitment

Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed

Prioritizes internal or external customer (i.e. patient, client, staff, vendor) requests to ensure prompt and effective response is provided.

Other duties

Participates in training sessions and other meetings as required by the health center and/or funding sources.

Participates in health center developmental activities as requested.

JOB SPECIFICATIONS

Education

High School diploma or General Education Degree (GED) is required. College education in related field is preferred.

Training and Experience

Two years of work experience processing insurance verification for Medicare, Medicaid, and Commercial Insurance payers is required. Medical Billing/Coding Certification and knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-10) knowledge is a plus.

Job Knowledge and Skills

Bilingual (English Spanish/ English-Creole) is required. Computer knowledge should include Microsoft Word, Excel and Outlook. Knowledge of Electronic Health Records (i.e., NextGen), Availity is highly recommended. Proven excellent customer service skills, phone etiquette, and outstanding communication skills are required. Good organizational and teamwork skills are required. Ability to work with multicultural and diverse population is required.

Contact Responsibility

The responsibility for internal and external contacts is frequent and important.

Other

Own transportation is required.

PHYSICAL REQUIREMENTS

This work requires the following physical activities: frequent sitting, bending, and standing, walking, talking in person and talking on the phone. Occasional driving, stretching/reaching and lifting to 50 lbs. are required. Work is performed in an office setting.