Verification of Benefits Specialist

Job Summary: The Verification of Benefits Specialist is responsible for verifying and confirming the benefits and coverage provided by a patients insurance plan. This includes ensuring that the services a patient is scheduled to receive are covered under their plan and determining the necessary information to process claims efficiently.

Key Responsibilities: ? Verify patient insurance information with insurance companies or other third-party payers. ? Confirm the patients benefits, including co-payments, deductibles, and coverage limits. ? Communicate with patients, providers, and insurance companies to clarify and confirm insurance coverage details. ? Review patient insurance policies to determine what services are covered. ? Obtain prior authorizations and referrals for specific procedures as required by insurance providers. ? Assist patients in understanding their insurance coverage and payment responsibilities. ? Maintain accurate and up-to-date patient insurance records in the database. ? Work closely with the billing and coding teams to ensure smooth claim processing. ? Resolve discrepancies or issues with insurance coverage by working directly with insurers or patients. ? Prepare and submit accurate benefit verification reports. ? Follow up on outstanding benefit verification issues to ensure timely resolution. ? Ensure compliance with all healthcare regulations and insurance provider policies. ? High school diploma or equivalent; some positions may require an associate or bachelors degree. ? Previous experience in medical insurance verification, billing, or coding is preferred. ? Knowledge of insurance terminology and procedures. ? Familiarity with medical billing software and Electronic Health Record (EHR) systems. ? Strong communication skills, both written and verbal. ? Attention to detail and strong organizational skills. ? Ability to handle sensitive patient information confidentially.

Skills:
? Proficient in Microsoft Office Suite.
? Knowledge of insurance verification platforms and databases.
? Ability to manage multiple tasks simultaneously in a fast-paced environment.
? Problem-solving and analytical skills to resolve insurance issues. Certifications:
? Certification in utilization management is preferred; licensure in nursing or social services is a plus.

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