Job Detail

Position: Insurance Verification / Authorization Representative FLSA Status: Full time, Non-Exempt Reports to: Barbara Araiza Summary/Objective: Responsible for contacting insurance companies to confirm insurance coverage and eligibility & authorization based on CPT codes by performing the following duties.

Essential Functions & Responsibilities: An employee must be able to perform these essential functions of the job, with or without reasonable accommodation Duties:

• Works closely with other departments as necessary to maintain patient and insurance records.
• Provides direct support to primary care practices and specialty care providers regarding authorization and eligibility activities.
• Becomes proficient in the use of ICD-10 and CPT codes.
• Performs electronic eligibility confirmation.
• Verifies eligibility of members and the participating status of the providers.
• Contacts providers with authorization and denial process information.
• Communicates with physician offices to resolve issues regarding prior authorization, pre-certification and referral forms.
• Determines the members benefit coverage.
• Verifies that all demographic and insurance information is correct and complete as well as obtaining any missing information.
• Verifies and documents patient's copay, co-insurance; deductible and out of pocket expenses.
• Utilizes various electronic verification systems, such as: UHC Online, Navinet, Waystar, Availity,Zirmed, etc.
• Provides professional, accurate, timely insurance verification and notification for the Clients.
• Obtains and inputs patient insurance information in Client Database, if needed.
• Updates patient insurance information or makes changes on an as needed basis.
• Ensures all account activity is documented in Spreadsheets in a timely and thorough manner.

Marginal Duties:

• Full-time position, and hours of work and days are Monday through Friday, occasionally work weekend and evening hours to meet client and company needs.
• Assist in any other areas as needed. Mental Demands: The mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. There are a number of deadlines associated with this position, which may cause significant stress. The incumbent must also deal with a wide variety of people on various issues.
• Must have intermediate computer and typing skills
• Must have excellent customer service skills.
• Must be detail oriented and able to work in a fast paced environment.
• Ability to manage multiple clients and projects/tasks simultaneously.
• Ability to communicate, direct, guide and fellow employees.
• Ability to communicate, direct and monitor clients.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Have strong analytical and organizational skills.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to handle stressful situations effectively and with composure as well as create solutions for similar future situations.
• Trustworthy Equipment / System use: Computer, MS Office, especially Word, Excel and PowerPoint ,Navinet, Laser Fiche, Medinformatix, AllScripts, Availity