Insurance verification

Harbor Health Services is an innovative, growing, mission-based organization that lives, serves and collaborates with our community members to achieve our mission to help individuals reach their full potential through access to local, affordable services that promote health.

Harbor provides medical, behavioral health, dental, and support services to more than 34,000 patients in Boston, the South Shore, and Cape Cod.

Harbor Health also operates two Programs for All-Inclusive Care for the Elderly in Mattapan and Brockton, providing comprehensive healthcare, transportation and social services for more than 580 frail elders who continue to live with dignity and independence in the community and a Woman, Infants and Children (WIC) Nutrition Program.

To help further the mission of Harbor, we are looking for a talented Insurance Verification Specialist to join our team at the Harbor Community Health Center in Plymouth.

Role :

The Insurance Verification Specialist verifies insurance eligibility for scheduled appointments prior to the date of service using various methods including online portals and calling insurance companies.

This position is responsible for confirming patients have active insurance coverage, appropriate PCP / plan assignments, and prior authorizations as required for the date of service to allow Harbor Health to bill for services rendered.

Responsibilities :

• Uses online portals or places calls to insurance companies to verify : Insurance eligibilityAppropriate plan and PCP assignmentRequired coverage
• Obtains prior authorization for certain services / payers as required.
• Reviews EPM reports as they relate to insurance / PCP assignment.
• Calculates cash estimates for patients on upcoming visits / procedures.
• Contacts patients regarding financial obligations and payment options.
• Serves as a patient educator on payment options, placing calls to patients for whom insurance coverage cannot be verified prior to their scheduled appointments.
• Discusses options with patients and works closely with the patients and the CHC’s Financial Counselors to ensure the patient has appropriate documentation when meeting with FC as needed.
• Accurately enters insurance information into EPM.
• Concisely, precisely and accurately documents all information and activity.
• Reviews encounters after the date of service to ensure the Patient Access team is following appropriate protocols and coordinates with department leaders to identify and satisfy training needs.
• Maintains clear communication with patients, insurance companies, and colleagues.
• Maintains strict confidentiality of patient and center-related business.

Requirements :

• High School Diploma or equivalent
• 1 year of experience with insurance verification, patient navigation, and / or health center patient assistance
• Skilled in attention to detail
• Knowledge of medical and dental insurance
• Basic Computer skills, including Microsoft Office 365 : Word, Excel, Outlook and Teams, Intermediate level preferred
• Excellent data entry skills, verbal and written communication skills
• Excellent organization skills and customer service skills
• May substitute 1 year of experience for bilingual capacity (English / Portuguese) and third-party billing experience
• Bilingual English / Portuguese or Spanish desired
• Medical and / or dental billing experience preferred

Monday -Friday 8 : 00 AM - 4 : 30 PM

Full Time 40 hours weekly

Last updated : 2024-05-15