Insurance Verification Specialist

As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care patients need to keep moving and keep enjoying their life.

The Insurance Verification Specialist will be responsible for validation of insurances for past, present and future appointments for Lakeshore Bone and Joint. 

Essential Functions:

• Validation of all Insurances using Allscripts/Payerpath Systems, checking the daily schedule two days prior to the patient being seen. 
• Communication with the appropriate departments regarding needed patient information. 
• Eligibility verification using the various insurance systems (Avality, Anthem BCBS, Medicare, Med Partners, Cigna, Indiana Medicaid, UHC, BCBS of Illinois)
• Review of claims that have denied due to eligibility errors, processing of corrected claims based on said eligibility errors, generating a corrected claim to updated/validated insurance
• Posting adjustments of denied claims that have denied due eligibility errors.
• Working eligibility claims in the queues as assigned
• Attend and participate in meetings as necessary
• Effective leadership of team environment
• Superior judgment and decision-making skills
• Strong ethics and a high level of personal and professional integrity
• Adaptive and flexible
• Effective communicator at all levels in the organization
• HIPAA compliance
• Other duties as assigned

 Education:

High school diploma or Equivalent

Qualification:

• Must be at least 18 years of age
• Must have reliable transportation
• Proficiency in Microsoft Word, Excel, and Outlook
• Digital literacy

Minimum of two-year working with medical insurance(s) or Patient registration experience

 

Required Skills:

• A strong comprehension of insurances regarding priorities, coordination of benefits, additional information.
• A full understanding of what a PPO, HMO, Medicare, Medicare Replacement, Medicaid, Medicaid Managed Care Plans, Government Funded plans tell. 
• Great attention to detail
• Strong analytical skills
• Employ critical thinking and problem solving
• Time management, prioritization, and sense of urgency
• Strong oral, written and persuasive skills
• Maintain patient confidentiality

Physical Requirements:
While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts.  Work may require hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear.  While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

Compliance:
All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete required compliance training modules, and report any observations of non-compliance.

EEO Statement:
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

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Last updated on Oct 28, 2024