Physician Partners of America

  • Insurance Verification Specialist- Pain Practice

    Job Locations US-FL-Tampa
    Job ID
    2018-1722
    Category
    Healthcare & Medical
    Type
    Full-Time
  • Overview

    Insurance Verification Specialist

    Physician Partners of America (PPOA) is an established and growing multidisciplinary integrated healthcare organization. We have multiple ASC, clinic, pharmacy, and laboratory locations in both Texas and Florida with our corporate headquarters in Tampa, FL.

    We are looking for an experienced Insurance Verification Specialist responsible for verification and authorization of insurance benefits for patients scheduled at PPOA facilities. The specialist must provide exceptional customer service to internal customers and patients. This position reports to the Manager of Verifications and Authorizations. By simply doing what you do best, you can help patients reach better outcomes at PPOA.

    Responsibilities

    • Verify insurance IN or OUT of Network utilizing several online payer portals.
    • Verification of benefits is for new and established patients within a clinic, procedure suite or diagnostic testing (MRI, X-Ray, CAT scan) setting.
    • Understand insurance payer deductibles, out of pocket, co-Insurance, In and Out of Network coverage including request for GAP exceptions for payers that are Out of Network.
    • Responsible for updating insurance information into patients account as well as verifying and updating patient demographics in required systems.
    • Acts as liaison between patient, physician office, and insurance company to assist concerning financial responsibility.
    • Inform patient to contact their primary care physician to obtain referral prior to the patient visit or instruct patient to bring referral at time of appointment.
    • Complete insurance verification on each patient and call patient back if unable to obtain verification with insurance carrier and properly documents findings in practice management software.
    • Communicates with insurance payers on benefit details, coverage requirements, referrals and authorization requirements for set date of service for patients.
    • Work independently while maintaining confidentiality and following HIPAA regulations.
    • Cross train as required to assist with overflow responsibilities.
    • Enter data information into system for accuracy of patient demographics and payer details.
    • Works closely with clinics to assist with patient verification of benefits and building solid working relationships fostering a teamwork environment.
    • Manages daily workflow in a production environment and utilizing all available resources to complete daily work assignments in a timely basis.
    • Supports a teamwork environment and participates in required meetings as needed.
    • Reading and interpreting insurance explanation of benefits, specifically for secondary claims.
    • Regularly attend monthly staff meetings and continuing educational sessions as required.
    • Maintains work operations by following policies, procedures, and reporting compliance issues.
    • Maintains quality results by following standards set forth by the company.
    • Updates job knowledge by participating in educational opportunities, reading professional publications, keeping current on Medicaid/Medicare billing, and reimbursement procedures.
    • Other assigned duties as assigned.

    Qualifications

    • High school diploma.
    • Minimum of two years of experience with medical office billing procedures, insurance verification and authorization is preferred.
    • Billing Certification a plus
    • Knowledge working in online payer portals such as: Availity, Navinet, Orthonet, etc.
    • Knowledge of the referral requirements from payers and clearly communicates with patients when additional supporting information is needed to complete benefit verifications prior to patients scheduled appointment.

    PPOA celebrates and supports diversity and is proud to be an Equal Opportunity Employer. PPOA performs criminal background checks and pre-employment drug screens.

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