Verification Specialist
Brief description
The Verification Specialist verifies and manages patient health care insurance benefits. Key responsibilities include communicating with insurance companies to confirm patient benefits, details, policy dates, and insurance plan specialist specifics. This fully remote position involves proactive tasks such as confirming prior authorizations, reviewing medical records, and processing DME orders. This role collaborates with multiple teams, addresses billing discrepancies with insurance companies, and meets or exceeds KPIs in a dynamic, virtual environment.
Essential Functions
• Perform daily verifications for DME equipment across multiple locations, ensuring accuracy, completeness, and compliance with regulatory requirements and insurance guidelines.
• Collaborate with healthcare providers and insurance companies to initiate and manage the Verification process for DME equipment ensuring timely verifications and minimized delays.
• Conduct thorough reviews of documentation, including patient records, insurance claim, and Prior Authorization forms, to ensure accuracy, consistency, and adherence to regulatory requirements.
• Work closely with healthcare providers, insurance companies, and internal teams to address documentation-related queries, resolve issues, and ensure seamless coordination in the verification process.
• Continuously evaluate and enhance verification processes to streamline workflows, improve efficiency, and reduce errors. Identify opportunities for automation or system enhancements to expedite documentation review process.
• Collaborate with the division’s team members to ensure workload distribution, knowledge sharing, and support in meeting daily targets and deadlines.
• Stay up to date with industry regulations, insurance guidelines, and compliance standards. Ensure all verifications adhere to relevant requirements and maintain patient privacy and confidentiality.
Qualifications and requirements
• High School or equivalent required.
• One year of experience in handling insurance matters.
Competencies
• Strong attention to detail.
• Excellent communication and interpersonal skills.
• Organized and self-motivated.
Physical Requirements
Prolong periods sitting at a desk and working on a computer.
Must be able to lift up to 15 pounds at times.
Discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, age (40 or older) or genetic information (including family medical history) is illegal and will not be tolerated. In addition, we will provide reasonable accommodations (changes to the way things are normally done at work) to applicants and employees who need them for medical or religious reasons, as required by law.
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