Insurance Specialist

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• Prioritizes workload to ensure all patients are authorized prior to their exam
• Determines if patient's insurance is a part of the provider network
• Makes outgoing calls to insurance companies for pre-certification or any authorization
• Receives pre-authorization from patients and/or insurance companies and documents
• Contacts patient and referring offices using HIPAA guidelines prior to scheduled exam when additional insurance information is needed
• Accurately enters a variety of information including date schedule requests received, patient name, referring physician and procedures into computer system
• Maintains positive interactions with referring offices, patients and staff
• Obtains signs and symptoms in order to support medical necessity
• Obtains all workers compensation approvals from insurance companies prior to scheduled exam
• Completes payor-related information i.e., payor, payor class, date of appointment

• Verifies insurance eligibility and benefits
• Calculate patients expected financial responsibility
• Notify patients of expected financial responsibility

• High school diploma or equivalent
• Prior experience with managed care and physician office scheduling
• Proficient with using computer systems and typing
• Knowledge of medical terminology
• Knowledge of CPT and ICD-10 coding
• Ability to read and interpret physician notes, diagnosis and other clinical documentation
• Ability to multitask
• Ability to focus and maintain direction in the tasks at hand under pressure

• 1-2 years previous health care experience working with a variety of health insurance plans for pre-certification and authorization of benefit coverage
• Bilingual