Insurance Verification Coordinator- Advanced Orthopaedics & Sports Medicine

The Insurance Verification Coordinator plays a crucial role in ensuring that patients receive the necessary insurance coverage for their medical services. This position involves verifying patient insurance information, determining eligibility, and communicating with insurance providers to resolve any discrepancies. The coordinator will work closely with healthcare providers and administrative staff to facilitate a smooth patient experience and minimize delay in service. By accurately processing insurance verifications, the coordinator helps to ensure that the organization receives timely reimbursements for services rendered. Ultimately, this role contributes to the overall efficiency and effectiveness of the healthcare delivery system.

Key Responsibilities:

• Complete all office visit/surgery verification, authorization/precertification to improve customer satisfaction allowing no more than 2 weeks.
• Completes and provides surgical/injectable estimates to patients.
• Contacts insurance company for authorization/precertification requirement, initiate request and deliver pertinent medical records, i.e., chart notes, diagnostic imaging reports, and op notes, to expedite process; obtains patient eligibility and benefits via phone (live/automated) or online portal.
• Notates pertinent information in the system regarding patient insurance verification/pre-certification status and patient financial responsibility.
• Conducts self a positive role model and team member
• Recognizes patients’ rights and responsibilities and supports them in performance of job duties
• Performs according to established compliance policies and procedures
• Seeks new learning experiences by accepting challenging opportunities and responsibilities
• Acts as liaison with the supervisor to ensure verification, precertification needs are met. (i.e. verifier having difficulty obtaining benefits, precertification coordinator having difficulty obtaining pre-cert, etc.)
• Assists the administrator and/or supervisor with various administrative projects as directed. (i.e., auditing rejected claims etc.)
• Works with the supervisor to ensure cross-training of all staff and reassign (in the absence of the supervisor) responsibilities for coverage when a staff member is out.
• Assists supervisor in training staffs who are failing to perform according to the department/organizational standard.
• Any additional duties as assigned

Required Skills & Competencies:

• High school diploma or equivalent
• Previous experience in a healthcare or insurance-related role
• Strong attention to detail and accuracy in data entry
• Associate degree in healthcare administration or a related field
• Familiarity with medical terminology and insurance coding
• Experience with electronic medical record (EMR) systems
• Language Ability: Able to read and comprehend simple instructions, short correspondence or memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Ability to speak and communicate in Spanish is beneficial.
• Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Computer Skills: Basic computer skills and operational knowledge are required. Good typing skills
• Certificates and Licenses: None required.
• Personal Skills: Insurance Verifier must have a pleasant and efficient manner in person and over the phone. Accuracy and attention to detail is essential to the job. The ability to work well under pressure and an awareness and understanding of other cultures are also important. Needs to have reasonable planning and organization skills as well as multi-tasking and prioritization abilities