Insurance Verification Specialist

Position Purpose

The Insurance Verification Specialist will be able to interpret and understand Medical Insurance policies. The Insurance Verification Specialist is responsible to verify eligibility, criteria, and limitations of the plan. This position enables Dental providers to understand benefits allowing patients to access optimal health services. This position will provide Initial verification for medical plans for new patients and update existing patients when necessary.

Objective / Detailed Responsibilities

The objective is full verification of Medical Benefit to ensure patients health care benefits cover required procedures. These are to be communicated to the provider with criteria and limitations. Responsibilities include, but are not limited to:

Outline of benefits and limitations of plan to be entered into CS system


Plan summary and benefits to be entered into the CareStack system

Communication with Provider regarding eligibility and plan limitations.

Knowledge of CPT codes and basic medical terminology

Collect initial data from provider review medical necessity.

Call to obtain pre-authorization for recommended services and procedures.

Communication with health plan re: status of pre auth

Once prior authorization needs have been determined or none needed, communication Medical Claims Specialists that claim initial claim preparation can begin.

Qualifications
The ideal candidate will have substantial work experience in the Medical Insurance Verification Process.In this role, you will verify insurance coverage for new patients. Duties will involve calling to obtain pre-authorization for services, which requires strong phone communication skills.

Medical billing experience (2 years preferred)
Knowledge of CPT codes and basic medical terminology
Excellent phone communication skills
Postsecondary degree or equivalent experience
The ideal candidate will also have excellent communication skills verbal and written.