Position Title RCM – Insurance Verification Specialist

Position Summary Information: Essential Duties and Requirement Details

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Position Summary The Insurance Verification Specialist is responsible for verifying patient insurance coverage and benefits to ensure accurate billing and claims processing. This role involves interacting with patients, clinicians, and insurance companies to obtain and confirm necessary information. The specialist will also manage and update patient insurance information in the system, ensuring compliance with all relevant regulations.

Essential Duties & Functions • Verify patient insurance coverage and benefits eligibility using the EPIC Real Time Eligibility module.

• Interact with patients, healthcare providers, and insurance companies to obtain necessary information.

• Coordinate with clinical staff and operations to ensure all required documentation for insurance verification is available.

• Update insurance and patient information in the EPIC system as necessary.

• Follow up on any issues related to insurance verification and claim submission.

• Navigate insurance company websites and online tools to confirm details of coverage.

• Resolve patient billing and insurance inquiries and disputes.

• Communicate with patients regarding their insurance coverage and benefits including financial obligations.

• Comply with all privacy and confidentiality rules and regulations.

• Document in record of all interactions for reporting and audits.

• Communicate with Revenue Cycle Management (RCM) Leadership to report trends, issues, and system optimization opportunities.

Required Education, Certifications, Licenses, & Training

(minimum requirements) • High School Diploma or Equivalent.

• EPIC Certification preferred but not required.

Required Years of Experience

(minimum requirements) • Minimum of 1 year of experience in insurance verification with FQHC experience preferred but not required.

Required Knowledge, Skills, and/or Abilities • Proven work experience as an Insurance Verification Specialist or similar role in healthcare setting.

• Excellent understanding of insurance benefits and eligibility, medical terminology, and coding specific to Ins. Verification.

• Proficiency in Real Time Eligibility and payer portal navigation.

• Ability to work independently and manage time effectively to achieve daily productivity measures.

• Excellent verbal and written communication skills.

• High level of accuracy and attention to detail.

Physical & Mental Demands

(Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position) • Frequently required to sit; occasionally required to stand and walk.

• Frequently required to talk and/or communicate both expressively & receptively.

• Occasionally required to lift and/or move up to 25 pounds.

• Occasionally required to bend, twist, climb, and reach.

• Moderate concentration/intensity, which includes prolonged mental effort with limited opportunity for breaks.

• Normal memory, taking into consideration the amount and type of information.

• Moderate level of complexity for decision making.

• Must be able to handle normal levels of intensity.

Work Environment • This position is 100% remote, with occasional in-office attendance as required.

• May be exposed to infectious waste, diseases, conditions, etc., including viruses.

• The noise level in the work environment is usually moderate to loud.

• May work in open areas at times and exposed to various distractions.

Organizational

Competencies All Tampa Family Health Centers’ staff are required to follow and uphold Tampa Family Health Centers’ Mission, Vision, and Values, Tampa Family Health Centers’ Policies and Procedures, The Code of Ethics and Compliance Plan. In addition, the following competencies are expectations for all employees:

Respectful and Courteous to Others

Employees refrain from disruptive and disrespectful behaviors that could be offensive to patients and employees, potentially creating a disruptive work environment.

Upholds Confidentiality of All Sensitive Data

Employees respect the rights of privacy of our patients and employees, including adhering to all HIPPA compliance regulations.

Values Cultural Differences

Employees are courteous and respectful in interactions with employees, patients, and our community.

Responsive

Employees respond quickly, graciously, and appropriately to employees and patients.

Clear and Effective Communication

Employees are personally accountable to foster positive and clear communication with all employees and patients.

Teamwork and Adaptability

Employees contribute positively to the Tampa Family Health Centers team and are committed to treating others with courtesy, honesty, and respect. Exhibits ability to handle and adapt to changing work environments or unexpected events. Ability to change methods approach to best fit situations.