Medical Insurance Verification Specialist

Job Description

Job DescriptionDescription:

We are seeking an experienced Medical Insurance Verification Specialist to join our growing neurology practice. This is not an entry-level position. The ideal candidate must have a strong understanding of medical insurance plans, eligibility verification, authorizations, and managed care. Candidates without direct medical insurance verification experience will not be considered.

Requirements:

• Minimum of 2 years of medical insurance verification experience in a physician practice or specialty clinic.
• HMO and PPO insurance plans
• Medicare and Medicare Advantage
• Medi-Cal
• Commercial insurance plans
• IPA/Medical Groups
• Referral and authorization requirements
• Experience working with major California health plans and medical groups.
• Strong understanding of insurance eligibility and benefit verification.
• Excellent attention to detail and problem-solving skills.
• Ability to prioritize work in a fast-paced medical environment.
• Strong computer skills and experience using an EMR.
• Experience navigating Insurance Portals

Responsibilities:

• Verify patient insurance eligibility and benefits prior to appointments.
• Review referrals and authorization requirements.
• Understand and verify HMO, PPO, Medicare, Medicare Advantage, Medi-Cal, and commercial insurance plans.
• Identify contracted and non-contracted health plans and medical groups.
• Verify PCP assignments and medical group affiliations.
• Obtain and document insurance information accurately in the electronic medical record (EMR).
• Communicate with insurance companies, medical groups, referring offices, and patients regarding coverage and authorization requirements.
• Resolve insurance discrepancies prior to patient appointments.
• Work closely with scheduling, referrals, and clinical staff to ensure timely patient care.
• Maintain strict confidentiality

*Self-motivated with a strong work-ethic, solid interpersonal skills and excellent organization and prioritization skills.

*Excellent phone etiquette and customer service skills

*Work efficiently under deadlines *Dependable / Punctuality is a must.