Insurance Verification Specialist

Medcloud’s Insurance Verification specialists have the primary responsibility of reviewing insurance benefits and insurance requirements on patients. This position will contact the appropriate insurance company via telephone and/or insurance website for the purpose of a) identifying patient eligibility, b) obtaining eligibility dates, c) obtaining information regarding deductibles, co-payments and co-insurance amounts due, d) obtaining information regarding authorization requirements and e) documenting all information in the patient’s account.

Duties include, but are not limited to:

• Obtains, clarifies, and confirms patients’ medical benefits, ensuring proper billing of services.
• Verifies and/or obtains the necessary referral, authorization, or pre-certification prior to services being provided as required by the payer.
• Ensures accurate, complete, and timely capture and data entry of patients’ demographic, financial, and clinical information into required system(s).
• Estimates self-pay portions (deductibles, co-pays, non-covered services) after benefits have been determined.
• Obtains authorization for ongoing services, as required by payors.
• Documents authorizations or denied authorizations in appropriate systems as per protocol.
• Maintains regular communication and follow-up with patients, families, as well as programs/departments, to include 1) clinical team, 2) leadership team, and 3) billing department. Keeps all applicable parties informed of pending referrals, authorizations, unanticipated delays, and/or other potential issues.
• Forwards supporting documentation in a timely manner to clinicians, company leadership team, and billing department.
• Completes all documentation, system entry, scanning and filing as required.
• Cross-trains in various office tasks and supports all office and customer service duties as needed.
• Maintains a deep understanding of all major insurance plans and products