Job Title: Insurance Verification Specialist

Company: TPIRC

Location: Long Beach, CA

Hours: Full Time Exempt; M-F 8AM-5PM

Pay Range: $17-19 per hour

Who We Are:

The Translational Pulmonary & Immunology Research Center (TPIRC) is a cutting-edge research and clinical care center that is revolutionizing treatment for rare and orphan diseases. Through the use of comprehensive diagnostic tools and patient-driven research, we seek to improve the quality of life for children and young adults each and every day.

Why TPIRC?

TPIRC is home to many innovative thinkers, problem solvers, and passionate leaders. The work we do is truly life-changing for our patients and their families; each member of our team will experience how their role supports our mission! TPIRC provides a challenging and rewarding environment where employees’ talents are leveraged, ideas are encouraged and growth is always inspired.

Who Are We Looking For?

We are currently seeking an Insurance Verification Specialist. The Insurance Verification Specialist is responsible for maintaining insurance and benefit coverage for TPIRC’s patient population. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, and clinical departments to verify insurance coverage and plan benefits are current and accurate. This individual is responsible for resolving eligibility and benefit inquiries, updating the EMR/PM system(s), and communicating outcomes to other stakeholders within TPIRC. The Insurance Verification Specialist will demonstrate knowledge in all areas of the medical billing process and will serve as the insurance eligibility and benefits expert for the organization.

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Benefits:

• Health Insurance
• Vision Insurance
• Dental Insurance
• PTO Days
• Paid Holidays
• 401K Plan (matched)
• Professional Development
• Paid Training
• Company Sponsored Events
• Competitive Rates
  
• Growth Opportunities

Essential Functions:

Eligibility and Benefits Verification:

• Perform eligibility and benefits inquiries for both new and established patients prior to patient appointments.
• Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding insurance eligibility and benefits coverage.
• Determine and maintain/update copayment, coinsurance, deductible, and out-of-pocket amounts.
• Respond to and resolve eligibility and benefit verification tickets via Salesforce.
• Respond to email and phone calls related to eligibility and benefits verification.
• Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
• Responsible for creating authorization orders and submissions via the EMR system.
• Responsible for verifying COB information and communicating with the health plan and/or guarantor.
• Ensure and document appropriate follow-up.
• Provides patient education of services and benefits.
• Proficient with turnaround time compliance in all aspects of the eligibility and benefits verification process
• Performs job duties with oversight.
• Other duties as assigned.

General:

• Collaborate with patients or customers, third party institutions and other team members to research and resolve billing inconsistencies and errors.
• Collect and maintain patient demographic and medical information required for medical billing.
• Ensure patient documentation is scanned and filed correctly within the Electronic Medical Record (EMR.)
• Provide exceptional customer service.
• Maintain and understand various medical billing software platforms.
• Navigate insurance websites and answers customer inquiries.
• Understand office visit fees including procedure and diagnosis codes.
• Maintain confidentiality and adhere to HIPAA regulations.
• Complete assigned tickets as required.
• Adhere to policies and procedures, update of forms and manuals.
• Assist in development and communication of SOP for key areas to improve accuracy and understanding of processes.
• Support daily, weekly, and monthly medical billing metrics.
• Identify issues and present possible solutions and/or suggestions to management.
• Interfaces with other departments to resolve medical billing workflows.
• Assist other staff and support the team approach.
• Communicate appropriately and clearly to management, co-workers, and physicians.
• Maintain all reference material that is provided by the supervisor, manager, or director.
• Know and follow the Employee Handbook policies and procedures.
• Maintain patient confidentiality so that HIPAA compliance is observed at all times
• Demonstrate honesty and integrity in everyday activities.
• Arrive to work on time.
• Consistently be at work.

Qualifications:

• High School diploma or equivalent required.
• Customer Service experience required.
• Medical billing and coding certification strongly preferred.
• 3+ years of experience in medical billing strongly preferred.
• 3+ years of experience in a specialty group practice preferred.
• Comfortable navigating across various computer systems to locate critical information.
• Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
• Experience with payor portals and affiliates.
• Experience with EMR and PM systems (Athena, AdvancedMD a plus)
• Experience using Salesforce a plus
• Must have strong analytical skills, proficient with spreadsheets
• Knowledge of health networks, IPA, HMO, PPO and contract affiliations.
• Exceptional organizational, presentation, and communication skills, both verbal and written.
• Proficiency in meeting deadlines and prioritize workload.
• Ability to work independently, with direction, and as part of a team.
• Experience with Microsoft Office Suite
• Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.

Working Conditions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee will be required to sit for long periods of time. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

The Translational Pulmonary and Immunology Research Center (TPIRC) provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws.

TPIRC is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act. TPIRC is an Equal Opportunity Employer and participant in the U.S. Federal E-Verify program.

Please note that TPIRC has adopted a mandatory COVID-19 vaccination policy for all employees. We believe this approach to be most effective in ensuring the continued safety of our team and our patients, and congruent with the local and national guidance provided to workers within the healthcare industry.

Should you choose to join the organization, you will be required to submit appropriate documentation within the first 45 days of employment. TPIRC will make reasonable accommodations due to disability or religious reasons, as required by law. Temporary deferrals may also be requested (i.e. pregnancy or recent COVID-19 illness).