Summary
The Insurance Verification Specialist supports outpatient rehab office staff by researching and verifying patient health insurance eligibility, interpreting insurance benefits for a specific service and documenting this information into EMR system. Insurance verification specialist identifies when insurance authorization is required, initiates prior authorization request and submits supporting clinical documentation to obtain approval for services provided by outpatient rehab clinics.
Essential Functions
Research and verify patient health insurance coverage and eligibility. Register patient coverage accurately within EMR to ensure timely billing and reimbursement from payer
Obtain and interpret specific program benefits under patient health insurance plan by using online portals or phone calls to payer
Concisely and accurately document patient benefit information within EMR system to generate patient estimates
Effectively communicate benefit information to patients, as needed. Answer detailed patient questions regarding out of pocket costs, as indicated under their specific insurance plan
Initiate prior authorization requests with insurance payer, submit clinical documentation that supports medical necessity for request and follow up on authorization status prior to patient’s first scheduled visit
Maintain clear, timely communication with front office staff regarding insurance benefit barriers that may prevent patient conversion, or delay prior authorization approval prior to first patient visit
Qualifications
Minimum: High School Diploma or GED
Minimum Experience: 1 year of experience in insurance verification
Many of our opportunities reward* your hard work with:Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com