Intake Specialist – Insurance Verification

Role Overview

• Accurately enters referrals within allotted timeframe as established; meeting productivity and quality standards as established
• Communicates with referral sources, physician, or associated staff to ensure documentation is routed to appropriate physician for signature/completion
• Works with leadership to ensure appropriate inventory/services are provided
• Communicates with patients regarding their financial responsibility, collects payment and documents in patient record accordingly
• For non-Medicaid patients communicate with patients
• Responsible for reviewing medical records for non-sales assisted referrals to ensure compliance standards are met prior to a service being rendered
• Follows company philosophies and procedures to ensure appropriate shipping method utilized for delivery of service
• Answers phone calls in a timely manner and assists caller
• Reviews medical records for non-sales assisted referrals to ensure compliance standards are met prior to a service being rendered
• Demonstrates expert knowledge of payer guidelines and reads clinical documentation to determine qualification status and compliance for all equipment and services
• Works with community referral sources to obtain compliant documentation in a timely manner to facilitate the referral process
• Contacts patients when documentation received does not meet payer guidelines, provide updates, and offer additional options to facilitate the referral process
• Works with sales team to obtain necessary documentation to facilitate referral process, as well as support referral source relationships
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation
• Works with insurance verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments
• Assume on-call responsibilities during non-business hours in accordance with company policy
• Supervise and provide guidance to team members in daily operations and complex case resolution
• Lead team meetings and facilitate training sessions for staff development
• Monitor team performance metrics and productivity standards, providing feedback and coaching as needed
• Serve as primary escalation point for difficult customer issues and complex regulatory compliance questions
• Develop and implement process improvements and workflow optimization strategies
• Coordinate with management on staffing needs, scheduling, and resource allocation
• Conduct new employee onboarding and ongoing training programs
• Maintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisions
• Prepare reports and analysis on team performance, trends, and operational metrics for management review
• Maintains patient confidentiality and functions within the guidelines of HIPAA

Requirements

• High school diploma or equivalent required
• Associate’s degree in healthcare administration, Business Administration, or related field preferred
• Related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry
• Exact job experience is health care organization, pharmacy that routinely bills insurance or provides Diabetics, Medical Supplies, HME, Pharmacy or healthcare (Medicare certified) services
• Specialist Level: (Entry Level): One (1) year of work-related experience
• Senior Level: One (1) year of work-related experience plus Two (2) years exact job experience
• Lead Level: One (1) year of work-related experience plus Four (4) years exact job experience

Benefits

• N/A