Summary: The Insurance Verification Specialist completes the daily verification and authorization process of all in and outpatient cases in the Charter Care Health of Rhode Island network. This process requires extensive knowledge of all third party contracts as they pertain to obtaining reimbursement for inpatient admissions and observation patients. The Specialist works closely with admitting, case management and the business office to assure the accuracy of information and timeliness of the verification/notification process. The Specialist will contact physician offices, Federal & State Agencies and third parties to obtain information required to assure payment of inpatient claims. The Specialist will meet daily with the Insurance Verification Coordinator to discuss specific issues including but not limited to private pay admissions, scheduled un-authorized admissions, or any case that could result in non-reimbursable visits. In association with the Coordinator this position is responsible for completing all duties associated with the notification/authorization and verification of in and outpatient cases at Charter Care Health of Rhode Island (RWH & SJHS) This position requires an individual with extensive knowledge of all third party rules and regulations. They must have exceptional documenting skills and possess excellent verbal and written communication skills. This position requires analytical ability to verify the accuracy of the information entered by other departments to assure reimbursement. The individual must be a highly motivated individual who is self-directed, professional, and accountable.

Education: Two years of college, or 3-5 years’ experience in a Medical Business Office setting.

Experience: Experienced in computer automated billing & collection process. Knowledge of third party regulations and compliance issues. Excellent verbal and written communication skills.