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INSURANCE VERIFICATION LEAD - CLINICAL RESEARCH
Newport Beach, CA The Insurance Verification Specialist Lead verifies insurance and benefits coverage for services in the assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, the status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts maintain charge entry and reconcile daily charges. Accurately enters insurance benefit and authorization information into patient accounts. Seeks assistance as needed to maintain service levels. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Performs other duties as assigned. Additionally, the Insurance Verification Specialist Lead participates in QA, training, and production duties for the Level I, II, and III positions. Acts as a resource, problem solves and makes decisions in the absence of the supervisor. Handles complex accounts and higher volumes. Serves as a Subject Matter Expert (SME) and internal resource for the team and participates in the department projects and initiatives. May complete employee schedules. May have responsibility for ensuring regulatory compliance. EDUCATION AND EXPERIENCE: *A high school diploma or equivalent is required. *Three years' insurance verification experience is required. *Intermediate knowledge of Windows computers and data entry required. *Experience with billing, insurance verification, coding, authorization guidelines, ICD 10 and CPT-4 coding, and/or medical terminology preferred. *Previous leadership role in medical, billing, or customer service setting preferred. *Degree and/or certificate or formal training in a related field preferred. CERTIFICATIONS: *Certification in Coding. |
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