Insurance Eligibility Verification Specialist

About the position Pinnacle Treatment Centers is a growing leader in addiction treatment services, providing care across the nation. Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works. As an Insurance Verification Specialist, you will work as an advocate for patients and facilities, serving as a liaison between operations and RCM. You will be responsible for obtaining insurance benefits, verifying eligibility status, and providing ongoing education for staff within the facilities. You will also be responsible for collecting accurate demographic and insurance information for the revenue cycle data entry team.

Responsibilities

• Responsible for verifying patients’ insurances, as well as their covered benefits and for confirming pre-authorizations for services.
• Works well as part of a team and effectively communicates. Assists practice staff with eligibility, as necessary.
• Serves as a liaison between the RCM department and the various PTC facilities.
• Handle high volume of inbound/outbound calls for patients that need to be screened financially and medically for financial assistance.
• Complete verification of benefits for multiple clients within the appropriate timelines.
• Maintains high quality customer service standards in compliance with federal and state regulations and guidelines. Provide periodic processing status updates.
• Assist in researching reimbursement issues relevant to benefits/eligibility issues.
• Assist in training of new team members.
• Enter and update patient demographics into the billing system as needed.
• Complete KPI reports as requested by management and the clients.
• Update and manage the VOB tracker for multiple clients.
• Understand federal and state requirements regarding client confidentiality and the principles of maintaining protected health information (PHI).
• Work effectively and maintain expected productivity.
• Other tasks or duties as assigned.

Requirements

• Associate’s degree preferred or experience in lieu of degree.
• 1-2 years'+ experience in front-end medical office operations.
• Prior experience working in a role with a high volume of either inbound or outbound calls.
• Experience and knowledge of federal or state government agencies including Social Security, Medicaid and/or Commercial coverages, familiar with the healthcare revenue cycle touching patient accounts.
• Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievements of performance metrics.
• Experience with customer interactions which requires live, accurate documentation of the encounter.
• Previous experience collecting patient payments or copays.

Benefits

• 18 days PTO (Paid Time Off) + 8 paid holidays
• 401k with company match
• Company sponsored ongoing training and certification opportunities.
• Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance.
• Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP)
• Discounted tuition and scholarships through Capella University