Central Verification Specialist for Texas Work Comp and VA
Job Summary
The Central Verification Specialist for Texas Work Comp and VA is a vital position within our organization. This position is not only responsible for assisting new patients by verifying insurance coverage and explaining their insurance benefits, but also for obtaining authorization/re-authorizations prior to a patient starting therapy, as well as coordinating billing processes to facilitate optimal patient care. This role requires exceptional attention to detail, organizational skills, and the ability to communicate effectively with patients, insurance providers, and other healthcare professionals.
Duties:
- Insurance Verification: Conduct thorough verification of patients' insurance coverage to determine eligibility, benefits, and coverage limitations. Verify demographic information, policy details, copayments, deductibles, and any specific requirements or restrictions.
- Prior Authorization: Obtain prior authorizations from insurance providers for prescribed physical therapy services. Collaborate with healthcare providers and therapists to gather necessary documentation and submit authorization requests within specified timeframes. Monitor and track the status of authorizations, ensuring timely approvals.
- Billing Coordination: Collaborate with the billing department to ensure accurate and efficient processing of claims. Provide insurance-related information and documentation to support the billing process, including claims forms, treatment plans, and authorization details. Resolve any insurance-related issues or discrepancies that may arise.
- Communication and Patient Education: Interact with patients, their families, and insurance representatives to explain insurance coverage, benefits, and any financial responsibilities. Answer inquiries regarding insurance-related matters and ensure patients are aware of their coverage details, including copayments, deductibles, and out-of-pocket expenses.
- Documentation and Record Keeping: Maintain detailed and accurate records of insurance verifications, authorizations, and related communication. Update patient files and electronic health records (EHR) with pertinent insurance information. Adhere to privacy regulations and maintain the confidentiality of patient data.
- Stay Informed on Insurance Policies: Stay up to date with changes in insurance policies, regulations, and coverage guidelines. Attend training sessions, workshops, or conferences to enhance knowledge and understanding of insurance processes and industry trends.
- Collaborative Approach: Collaborate effectively with healthcare providers, therapists, and other clinic staff to ensure seamless coordination of care and accurate documentation of insurance-related matters. Foster positive working relationships with insurance providers to facilitate efficient claims processing.
- Ability to prioritize tasks/projects.
- Ability to build rapport with our patients over the phone.
- Thorough knowledge of the Physical Therapy field, as well as the skillsets and specialties of the therapists within our practice.
- Excellent oral and written communication skills.
- Strong analytical, organizational, and interpersonal skills.
- Ability to organize and prioritize work for multiple tasks/projects.
- Ability to work with clients and staff to build positive relationships, along with good communication and affinity.
- Ability to be a team player and team builder.
- Thorough knowledge of business English, spelling, punctuation, and proofreading.
- Ability to type at least 45 wpm.
- Must have sufficient knowledge of basic computer entry skills, word processing and spreadsheet computer programs, and be able to input data as assigned.
- Proven experience in insurance verification and authorization processes, preferably within a healthcare or physical therapy setting.
- Knowledge of medical terminology, coding systems (such as CPT and ICD-10), and insurance billing procedures.
- Familiarity with various insurance plans, including Medicare, Medicaid, private insurers, and managed care organizations.
- Proficient in using electronic health records (EHR) systems and billing software.
- Excellent attention to detail, organizational skills, and ability to manage multiple tasks simultaneously.
- Excellent communication and interpersonal skills to effectively interact with patients, insurance representatives, and healthcare professionals.
- Ability to work independently and as part of a team, demonstrating a proactive and problem-solving attitude.
- Understanding of HIPAA regulations and commitment to maintaining patient confidentiality.
- Must be a strong team player, energetic, with a focus on excellent customer service.
- Successful completion of on-the-job training required.
- The ability to keep good records and establish/follow a system.
- High school diploma or equivalent required, but additional education or certification in medical billing and coding, or healthcare administration, is preferred.
- Dental insurance.
- Health insurance.
- Paid time off.