|Job Title||Insurance Verification Specialist|
|Reports to||Chief Administrative Officer|
Job Title: Insurance Verification Specialist
FLSA Status: Non-exempt
Reports to: Communications Center Management
Under the general direction of the Communications Center Manager, the Insurance Verification Specialist is responsible for the performance of insurance verification, registration, charge validation and usage of approved ICD-10 and HCPCS Coding standards for coding. She/he is also responsible for reviewing ambulance trip reports to determine medical necessity and to assign the appropriate level of care. This also includes fulfilling assigned duties and responsibilities for the timely and accurate submission of all ambulance runs (government and non-government) in order to process third party claims and patient bills.
PRIMARY RESPONSIBILITIES AND DUTIES
The following essential duties and responsibilities are not all inclusive. Other responsibilities and duties may be assigned.
- Verify all demographic and insurance information is complete and correct for each bill and obtain any missing information. Utilization of various electronic verification systems, Gateway, Web Denis, Medicare Eligibility, and Internet based sites.
- Reviews run sheets and supporting documentation to determine medical necessity of the transport after the services have been provided. Assures compliance with all Federal, State and Local Rules and Regulations for billing ambulance services.
- Upon review of the medical chart, assigns appropriate Medical Necessity Modifiers.
- Assigns modifier for origin and destination.
- Reviews incomplete charts for deficiencies and assigns to appropriate ambulance operation manager for follow up and completion.
- Answers telephone and provides information according to established procedures.
- Makes necessary phone calls to obtain demographic and insurance information.
- Data entry.
- Reports quality and documentation issues to the department head immediately.
- Reviews all Medical Record Information to assign appropriate ICD-10 and HCPCS codes based upon the documentation of services provided to the patient.
- Keeps up to date on all insurance laws and procedures, (i.e. Government Programs, Medicaid, Medicare, Private and commercial Third Party Payers) to insure that billing and collection practices are legal.
- Assists Management team with ambulance front-end data problems in order to appeal denied claims, justifying reasoning for codes used and correcting as necessary.
- Serves as a resource to the Communication Center for all coding and billing questions and inquiries.
- Participates in Committees, special projects, and all other duties as assigned.
- Exhibits excellent customer service skills and behaviors toward internal and external customers and co-workers.
- Adheres to department customer service and performance standards.
This position has no responsibility to manage or lead a team.
EDUCATIONAL AND CERTIFICATION REQUIREMENTS AND WORK EXPERIENCE
- Minimum Education: High School Diploma or equivalent.
- Minimum Work Experience: One to two years of work experience in billing and coding experience preferred. Competitive applicants must have a working knowledge of medical terminology and are familiar with insurance and hospital billing policies and procedures.
- Certification, Licensure, Registration: Certificate in Coding within 9 months of starting position.
KNOWLEDGE AND SKILLS REQUIRED
Contacts with Others: Interacts with clients, leadership, ambulance crews and co-workers. As a member of the team, works collaboratively with all other team members towards meeting the goals of the organization.
Analytical Demands: Knowledge of the technical aspects of Medical Records Coding, Medical Terminology, and ability to search out primary data for coding. Must be detail orientated and possess excellent organizational skills.
Physical Effort: Mental and Visual Stress related to computer input, productivity, and chart review.
Work Environment: Normal office environment with limited exposure to health or accident hazards.
Equipment Used: Computer, telephone, collection system, printer, calculator, typewriter, fax machine, and copy reproduction equipment.