Job Description:
A verification representative is responsible for dealing with both incoming and outgoing calls and assisting clients with their insurance verifications. Verification representatives will be in charge of solving any insurance-related issues the customer may have, and thus must be trained with the proper company policy and procedures. These representatives must also have experience dealing with difficult customers, resolving conflicts, and customer service in general. Because of this, a company must look for an ideal employee who has experience with insurance-related work, as well as experience with customer relations, and ideally, telecommunications support.responsibilitiesVerify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician’s office and/or the patientDetermine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insuranceUtilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits, and/or pre-certs and authorization informationEnter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial classWhen the patient’s insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payersABC Company’s goal for each patient’s insurance verification is complete and accurate. The insurance verifier will document the findings in the patient account and will contact the patient with either estimated co-insurance, co-pay, and or deductible amounts due on or before the date of service as applicableThe Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patient’s prior to the date of service to review, Physician Ownership, Advance Directives and Patient Rights