Verification of Benefits Specialist

Job Summary: The Verification of Benefits Specialist is responsible for verifying and confirming the benefits and coverage provided by a patients insurance plan. This includes ensuring that the services a patient is scheduled to receive are covered under their plan and determining the necessary information to process claims efficiently.

Key Responsibilities: • Verify patient insurance information with insurance companies or other third-party payers. • Confirm the patients benefits, including co-payments, deductibles, and coverage limits. • Communicate with patients, providers, and insurance companies to clarify and confirm insurance coverage details. • Review patient insurance policies to determine what services are covered. • Obtain prior authorizations and referrals for specific procedures as required by insurance providers. • Assist patients in understanding their insurance coverage and payment responsibilities. • Maintain accurate and up-to-date patient insurance records in the database. • Work closely with the billing and coding teams to ensure smooth claim processing. • Resolve discrepancies or issues with insurance coverage by working directly with insurers or patients. • Prepare and submit accurate benefit verification reports. • Follow up on outstanding benefit verification issues to ensure timely resolution. • Ensure compliance with all healthcare regulations and insurance provider policies. • High school diploma or equivalent; some positions may require an associate or bachelors degree. • Previous experience in medical insurance verification, billing, or coding is preferred. • Knowledge of insurance terminology and procedures. • Familiarity with medical billing software and Electronic Health Record (EHR) systems. • Strong communication skills, both written and verbal. • Attention to detail and strong organizational skills. • Ability to handle sensitive patient information confidentially.

Skills:
• Proficient in Microsoft Office Suite.
• Knowledge of insurance verification platforms and databases.
• Ability to manage multiple tasks simultaneously in a fast-paced environment.
• Problem-solving and analytical skills to resolve insurance issues. Certifications:
• Certification in utilization management is preferred; licensure in nursing or social services is a plus.

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