Verification of Benefits Specialist in Orlando, FL

100% Onsite

Principle Responsibilities

• The following reflects management’s definition of essential functions for this job, but does not restrict the tasks that may be assigned.
• Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
• Responsible for direct communication and building relationship contacts with health plans to secure Single Case Agreements.
• Responsible for the management of all Single Case Agreements, including, tracking outcomes, identifying problem payers, negotiating rates (as needed), and securing required signatures.
• Oversees and ensures the accuracy of Single Case Agreements meets authorization and claims requirements.
• Collaborate with Provider Relations Manager, Verification of Benefits Manager and Revenue Cycle manager on payment analysis and providing feedback for new patient admissions and or continuation of care.
• Present feedback on outcomes and correspondence or lack of correspondence related to Single Case Agreements that present risk on reimbursement outcomes.
• Routinely evaluates Insurance Master, Plan Guidelines and non-contracted tools of current processes and make updates as needed based on Single Case Agreement outcomes.
• Acquires necessary medical records and documentation from customer charts to communicate via phone, fax or e-mail with other medical facilities, hospitals and insurance carriers.
• Follows all regulatory policies and procedures, privacy and security standards in accordance with government agencies to include HIPAA requirements.
• Performs other duties as assigned by superiors

Required Qualifications

• High School Diploma or GED required
• Three to Five (3-5) years’ experience in insurance benefit verification and/or collections and/or managed care contracting.
• Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices
• Understand the process for verification of benefits and collections as it relates to the policies and procedures for effective placement of customers and reimbursement.
• Complete Understanding of Medicare Rules and Regulations
• Advanced MS Office experience, with an emphasis on MS Excel desired
• Continued Self Improvement courses & seminars related to position along with “In House” programs provided by client

Preferred Qualifications

• Associate’s Degree is preferred
• Knowledge in Managed Care
• Knowledge in Contracting and Fee Schedules
• Strong Computer/Software Skills

Physical Requirements

• Must be able to work at a computer workstation for extended periods of time
• No lifting over 10 pounds required without assistance

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