Medical Insurance Verification Specialist

THIS IS A HYBRID ROLE!! ALL CANDIDATES MUST BE LOCATED IN THE STATE OF NEW JERSEY OR FULLY CAPABLE OF COMMUTING TO OUR ISELIN OFFICE.

Essential Duties and Responsibilities
Gathers insurance information entered in Nextgen.

Verifies eligibility by using Real Time, Web-MD or other web based systems for all established patients.

Contacts insurance company provider services by phone for all new patients to the practice and new insurance policies for established patients.

Utilize the eligibility/benefit tab within the insurance maintenance screen for insurance eligibility results.

Scan and file all insurance referrals and documents in NextGen document management prior to the patient’s appointment.

Obtains precertification for in office lasers, procedures, botox, and other injectables.

Alerts all patients prior to their appointments of inactive policies or difficulties obtaining eligibility or precertification with information gathered at the time of appointment scheduling.

Provides courtesy calls to all new patients prior to their appointments informing them of their benefits including copay, deductible, coinsurance or referral requirements from their PCP.

Provides a courtesy call to all established patients who require a new referral for their scheduled visits.

Assists patients in obtaining their insurance referrals prior to the patients visit. Requests referrals be issued on line or faxed in advance. All referrals received or retrieved on line are scanned in Nextgen document management and attached to patients electronic chart.

Conducts all on demand precertification and verification submissions requested by the Medical Office staff.

Verifies and updates/corrects claims addresses in the system.

Ensures patient referral source is kept abreast of patient care by entering all new referring physicians in the provider database and attaching new physician’s contact information to the patients’ electronic chart in all designated areas.

Manages all commission for the blind.

Documents and records all phone calls, fax submissions, incoming mail, and patient interactions that require the assistance of personnel or department for communication purposes.

Obtains authorizations for MRI’s and CAT scans ordered by physician.

Maintain a workflow 1 week ahead of schedule and may be required to be available off hours to complete verifications the 1st of the month before patients arrive for their appointment.

Requirements
High School Diploma or G.E.D
Minimum of one year Medical Billing and Coding/ Insurance Verification Experience (Preferred)