<p>POSITION SUMMARY:</p> <p>Under the general direction of the Insurance Verification Manager, ensures that patient's insurance information is accurate before the scheduled visit for billing and quality purposes. To ensure insurance claim reimbursement is verified for timely filing.</p> <p>KEY RESPONSIBILITIES:</p> <ul> <li>Checks eligibility of patients' insurance thru the batch system using the Clearance Change application </li><li>Corresponds with all SMG offices with any insurance related issues </li><li>Calls patients to obtain any new or existing insurance information that could result in claim denial. </li><li>Contacts self-pay patients if no insurance is captured thru other insurance modules and resources. If determined the patient is self-pay- refer patient to Financial Counselor, and notify office of deposit due at time of service. </li><li>Communicates with the patient's Primary Care Physician or Referral Department if a referral is required and not obtained. </li><li>Corresponds with the Referral department on any insurance changes or issues that may require a new referral or authorization that may cause a delay or denial of payment. </li><li>Communicates with 3rd party insurance carriers that are not automated thru Clearance Change, regarding eligibility and patient benefits; notifies office of all insurance limitation that will affect the billing process. </li><li>Provides insurance knowledge and direction to Patients, Call Center, SMG Practice sites, Patient Services and all modalities in ambulatory care regarding Insurance Eligibility and Meditech related issues. </li><li>Supports Patients and SMG Primary Care offices in Mass Health/ACO products and works with Mass Health Gateway to ensure PCP changes are correct in our ACO. </li><li>Informs billing department of incorrect insurance information for past billing deficiencies that may result in claim denial. </li><li>Notifies Customer Service on high balance accounts and accounts with minimal coverage to establish a payment plan. </li><li>Completes any special projects assigned by management. </li></ul> <p>REQUIRED KNOWLEDGE & SKILLS:</p> <ul> <li>Strong communication skills that ensure the ability to deal effectively and tactfully with patients, insurance carriers, and other employees. </li><li>Previous experience in a healthcare environment preferred. </li><li>Knowledge of Meditech, Clearance Change or other Insurance verification systems, helpful. </li><li>Ability to operate computers and navigate the internet. </li><li>Familiarity with Microsoft Office, a plus. </li></ul> <p>EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:</p> <ul> <li>Education: High School Diploma or Equivalent. </li><li>Experience: Previous experience in a healthcare setting preferred. </li><li>Certification/Licensure: N/A </li><li>Software/Hardware:, Microsoft Office and ability to navigate multiple internet-based applications. </li></ul>