Insurance Verification Specialist at Cardiac Imaging, Inc. – Oakbrook Terrace, Illinois

Summary/Objective:

The Insurance Verification Specialist is responsible for verifying patients’ insurance/benefits coverage for Advanced Diagnostic Imaging, PET/CT, tests and procedures. They review the insurance documents of the patient, including coverage and limitations and escalate concerns to the RCM Director for immediate resolution. The Insurance Verification Specialist communicates with insurance companies, billing team, and physician liaison specialists to ensure accurate billing and reimbursement for the PET/CT test. The role requires attention to detail, strong communication skills, time management skills and extensive knowledge of insurance policies.

Essential Functions:

The following list of essential functions is not intended to be restrictive or all inclusive. The fact that certain duties may not be listed does not limit the assignment of additional and/or other duties.

• Obtain insurance eligibility and benefit information using various phone and on-line resources.
• Obtain appropriate authorizations and notifies insurance companies of patient date of service as needed.
• Works with corporate scheduling staff and/or physicians’ offices to assure eligibility and authorization requirements are completed within the required timeframe.
• Communicates with the appropriate scheduling or billing staff when changes are made to the service date that will affect the reimbursement.
• Identifies appropriate corrections in the patient’s record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
• Immediately refers ‘at risk’ admission to eligibility, i.e., out of network, underinsured, max benefits, etc.
• Works with insurance eligibility responses and physician's staff and patients as needed to resolve billing issues and prevent billing delays.
• Maintains a satisfactory level of performance and adherence to workload standards.
• Estimates reimbursement and calculates expected payment based on appropriate fee schedules.
• Performs calculations using insurance benefit information to accurately estimate patient responsibility.
• Other related duties as assigned