Provides support to medical billing staff. Clarifies and verifies details of insurance coverage with private or government carriers and offers information to patients before medical services are provided. Tracks physician referrals and provides necessary details to billing staff. The position involves heavy phone interaction and demands top customer service and problem-solving skills in working with physicians, claims processors, medical billers and patients.

Job Summary

Premier Bone and Joint Centers is currently seeking an Insurance Verification Specialist. In this role, you will verify insurance coverage for new patients and referrals, as well as update information for existing patients. Your duties will also involve calling to obtain pre-authorization for services, which requires strong phone communication skills. 

Proactive

Anticipatory, change-oriented and self-initiated behavior. Proactive behavior involves acting in advance of a future situation, rather than just reacting. It means taking control and making things happen. Proactive employees generally do not need to be asked to act, nor do they require detailed instruction. Take initiative to see an issue and develop realistic solutions.

Achieve

Demonstrate effort, skill, or tenacity to reach or attain a desired objective, level of performance or quality of work. Carry out tasks successfully and completely. Attain goals despite difficulty. Able to exert the necessary effort using their own skill set to perform at the highest level desired within our organization.

Team Conscious

Demonstrate a genuine interest in thoughts and opinions, values, and needs of co-workers. Avoid speaking, writing, or doing other things that could be seen as disrespectful of patients and/or co-workers. Recognize and show respect for the strengths and contributions of others. Work with others to accomplish a common goal or objective.

Integrity

Act in ways that demonstrate personal reliability, honesty, and care that exhibit integrity and serves as a positive example of why others should trust the motives of our organization. View them self as a reflection of the organization by following through on commitments and accepting ownership of any mistakes they might make. Leave others with a clear impression that integrity is a core value of Premier Bone & Joint Centers. This is in contrast to individuals who make commitments that go unmet, fail to acknowledge their role in disappointing events, or whose actions (or inaction) leave others with doubts about the level of trust that should be placed in Premier Bone & Joint Centers.

Excellence

Have the will to win, the desire to succeed, the urge to reach their full potential. We are what we repeatedly do. Excellence is the path chosen to be successful at work. The word excellence is defined as the quality of surpassing the average, possessing high qualities in one's field. It’s about developing a winning mindset that says “I want to be great at what I do. I want my personal life and my work to be spectacular.” Developing excellence is a deliberate process and takes time, yet it can be developed by creating a personal strategy that will put you on the road to success in life and in the workplace.

Never Quit

Can always be counted on to go above and beyond what is asked. Always give extra and unending effort and offer support to other team members. Persevere in completing tasks and don’t get discouraged or cuts short efforts to accomplish goals and objectives. Make and fulfill commitments. Establish a pattern of working independence, always intend to fulfill any promise made, prepare for meetings and other tasks.

Trust

Believe that someone or something is reliable, good, honest, and effective. Act responsibly for the safety and care of Premier Bone & Joint Centers' patients. One is able to believe that something relayed by this employee, is true or correct even though you do not have proof of it. One is able to have firm belief in the reliability, truth, ability, or strength of this employee. This is an employee that one would put complete faith in and be confident that the integrity of this employee would guide their actions.

Communication

Communicate effectively, respectfully, and appropriately. Use good judgment as to what to communicate to whom by utilizing the chain of command, as well as the best way to get that accomplished. Speak in a clear and credible manner, selecting the right tone for the situation and audience. Listen to others and allow them to make their point. Be respective to feedback and respond accordingly.

Interpersonal Skills

Working Relationships

• Ability to establish and maintain effective working relationships with physicians, co-workers, and the public that harbor a friendly, yet professional interaction.  
• Demonstrate willingness to readily interact with other staff members and department.

Mentor

• Acts as mentor for new employees.

Personal Growth

• Accepts responsibility for own professional growth and personal conduct by seeking knowledge in work specific areas, taking advantage of opportunities at work to observe and volunteer.

Flexibility & Stressful Situations

• Ability to be flexible, organized, and function under stressful situations.

Adherence to Facility/Departmental Policy

Confidentiality

• Observe confidentiality of information in regards to patients, physicians, and fellow employees; ability to maintain confidentiality under HIPAA standards.

Attendance/Punctuality

• Maintain a good attendance record and arrive to work punctually.

Overtime

• Able to substantiate overtime, minimizes overtime and adjusts hours as needed.

Dress Code/Identification

• Follow dress code of department, appear professional when present in the clinic, wear identification while on duty, and communicate name and role to patient appropriately.

Cell Phone Use

• Cell phone may be used for business purposes only.  
• Utilizes cell phone for personal use only during breaks or meal periods out of the public eye.

Staff Meetings/In-services

• Participates in Premier Bone & Joint Centers and departmental in-services and staff meetings.

Safety & Infection Control Policies

• Adhere to safety and infection control policies.

Care of Environment, Equipment, & Supplies

Clean, Neat, Safe Environment

• Maintain a clean, neat, and safe environment for patients and staff, including personal work areas.

Office Equipment Skills/Malfunctioning Equipment

• Utilizing correct/safe technique when using equipment and notify manager of malfunctioning equipment.

Duties and Responsibilities

Verify insurance information for new patients and referrals

Update insurance information for existing patients

Call to obtain pre-authorization for recommended services and procedures

Inform relevant clinical staff about denials

Answer questions related to billing and insurance

Education:

High school diploma or GED certificate

Associate degree (or equivalent experience)

Physical Requirements:

Seeing - Must be able to read and use computer - Constant

Hearing - Must be able to hear well enough to perform telephone operations and to communicate with physicians, medical staff, administrative staff, co-workers, and patients/families - Constant

Speaking - Must be able to verbally communicate with physicians, medical staff, administrative staff, co-workers, and patients/families - Constant

Grasping - Must be able to write and type, as well as sort mail and perform activities requiring fine motor skills - Constant

Sitting - Constant

Standing - Rarely

Weight Demands:

Lifting - Must be able to lift up to 10 pounds - Occasionally

Working Conditions

Environmental Hazards 

• The fast paced environment may lead to increased levels of personal stress and demand high mental acuity.

Physical Hazards

• Physical harm is possible when performing physical requirements, as listed above.  
• Exposure to communicable disease, bodily fluids, and/or toxic substances is possible and can be physically harmful.