Clinical Verification Specialist

7 days ago


Quezon City, National Capital Region, Philippines Sourcefit DR Full time

Company Overview

We are a dynamic organization, Sourcefit DR, dedicated to delivering exceptional healthcare services. Our team is passionate about making a positive impact on patients' lives.

Job Summary

We are seeking an experienced Verification and Authorization Specialist to join our team. The successful candidate will play a critical role in ensuring compliance with Federal and State regulations and policies regarding benefit verification and authorization.

Responsibilities

  • Demonstrate thorough knowledge of patient insurance eligibility and benefits across various payers, including Aetna, Cigna, BCBS, Humana, Worker's Comp, Medicare, and Medicaid.
  • Enter insurance and authorization information into EHR systems accurately and following Standard Operation Procedures.
  • Follow up on pending or expired authorizations and referrals as assigned.
  • Review authorization denials for accuracy and initiate the appeal process until the case is resolved.
  • Maintain accurate records of all call details per the Standard Operation Procedures of the department.
  • Respond promptly to Quality Reviews.
  • Respect patients' rights and maintain patient privacy and confidentiality at all times.
  • Comply with HIPAA guidelines and regulations.
  • Develop a working understanding of NDC numbers, metric quantities, and infusion supplies.
  • Continuously expand knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
  • Collaborate effectively with other staff members.
  • Communicate positively and respectfully with colleagues and stakeholders.


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