Find & Apply For Enrollment / Eligibility Specialist Jobs in Spring, Texas

The Insurance Verification Specialist is responsible for obtaining verification from payers for Ambulance Transportation Services provided. This role is key to securing reimbursement and minimizing organizational write-offs. The Verification Specialist must be able to guide staff, providers, and/or patients on the options and complete the necessary steps to bring closure to the case. The Verification Specialist must consistently demonstrate skilled communication and troubleshooting techniques as well as excellent customer service skills. This position will have the ability to anticipate and respond to a wide variety of issues/concerns, and the ability to execute tasks efficiently and effectively. The position requires the ability to independently plan, schedule and organize numerous tasks as this position directly impacts reimbursement from insurance carriers.

Core Responsibilities:

Confirms the need and takes the appropriate actions to ensure the verification is obtained. Verifies the basic patient/service information is available - the minimum data set for scheduling a service. If not present, initiates appropriate activity to obtain the required data set, such as insurance. Prioritizes the urgency of the verification by anticipating the approximate time it may take obtain the verification from the insurance company, the complexity of the procedure and the scheduled date of service; follows up with insurance company to accelerate responses and expedite authorizations. Evaluates or assists with the evaluation of cases when the insurance company has denied payment to determine next steps. Interacts with medical and professional staff to obtain appropriate clinical documentation for review; Takes the appropriate actions when it appears that the authorization will be not be provided on a timely basis; to include escalation. Understands the critical delineations of patient transfer types (discharges, transfers, appointments, emergent, non-emergent) based on payor regulations and participates in the appropriate decision making with management. Advises and coordinates with the authorizations team regarding problematic transports requiring additional attention.

Customer Service Standards:

Support co-workers and engage in positive interactions. Communicate professionally and timely with internal and external customers Demonstrate friendliness by smiling while speaking to customers. Provide helpful assistance in anticipating and responding to the needs of our customers. Collaborate with customers in planning and decision making to result in optimal solutions. Ability to stay calm under pressure and deal effectively with difficult situations.

Insurance Verification Requirements:

Minimum of 2 consecutive years' experience in verifying insurance Medicare and Medicare advantage plan knowledge Bilingual Preferred Experience and knowledge in verifying all commercial and government payers Experience and knowledge with payer portals Verify and obtain coordination of benefits on each patient Ability to review and research patient and payer information for accuracy and make necessary corrections Must be detailed oriented, organized, able to multitask and manage time effectively Able to keep up with high volume workflow Must have excellent written and verbal communication skills Work well both independently and with others Customer Service experience is a plus but not required

Job Type:

Full-time Pay:

$16.00 - $19.00 per hour

Benefits:

401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Insurance verification: 2 years (Required)

Medicare/Medicare Advantage Plan:

1 year (Required)

Language:

Spanish (Preferred) Ability to

Commute:

Spring, TX 77388 (Required)

Work Location:

In person