Insurance Verification Representative

Northern Light Health
Job Description
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The insurance verification representative reviews insurance for all new patients; acquire necessary PCP authorizations and prior authorizations for services rendered by CCOM physicians; and documents requirements on authorizations on all patient accounts. The Insurance Verification Representative will determine insurance eligibility, coverage levels, and billing requirements for all medical oncology outpatient areas.

Duties/responsibilities to include, but not limited to:

· Telephone calls to employers and insurance companies and using electronic communication systems such as Internet sites, computer links, and electronic data exchange software.

· Work closely with the scheduling and patient account services to ensure accurate and timely billing of current accounts and to update internal databases for future registrations.

· Update the registration for patients admitted to the medical center, when necessary.

· Understanding of the complexities of health plans and the relationship between health plans e.g., Medicare, MaineCare, Commercial Insurances, Blue Cross, Worker's Compensations, and self-pay.

· Understanding and using more than nine computer systems in order to work efficiently.

· General understanding of their role in the revenue cycle.

MINIMUM EDUCATION REQUIRED: Associates degree or other technical college education or the equivalent (4 years) in work experience and continuing education. Medical Terminology 1 course completion.

MINIMUM EXPERIENCE REQUIRED: 1 - 2 years in a medical setting; 1 - 2 years work experience with personal computers and customer service; 1 - 2 years in Registration or Patient Account Services.
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