Insurance Verification Specialist

Insurance Verification SpecialistLocation:Northridge, California, United StatesRequisition #:21000MYUPost Date:4 hours agoCareers that Change LivesAs a key member of the Patient Financial Services (PFS) insurance verification team, responsible for all aspects of insurance eligibility, and benefit verification, including customer service, with the objective of minimizing controllable denials, and maximizing clean claim rate.Following prescribed policies and procedures, performs a variety of verification tasks, using standard healthcare guidelines. Obtains insurance coverage information from patient and payor, utilizing all available tools, including medical documentation, and contract information to select the appropriate financial status classification (FSC). Obtains accurate benefit information to identify patient financial liability. Enters data into computer systems using defined resources and programs, investigates questionable data, and recommends actions to resolve discrepancies.Executes on established department objectives and assignments which affect the immediate operation but that also have full revenue cycle and ultimately company-wide financial impact.We believe that when people from different cultures, genders, and points of view come together, innovation is the result and everyone wins. Medtronic walks the walk, creating an inclusive culture where you can thrive.Diabetes Business Description:The Diabetes Operating Unit focuses on improving the lives of those within the global diabetes community. As a business, we strive to empower people with diabetes to live life on their terms by delivering innovation that truly matters and providing support in the ways they need it. Were committed to meeting people with diabetes where they are in their journey, always with an aim to make their lives easier. Our portfolio of innovative solutions are designed to provide customers greater freedom and better health, helping them achieve better glucose control, while spending less time managing their disease.Click here (https://www.medtronicdiabetes.com/home) to learn more about products.A Day in the LifeProvide eligibility and insurance verification support to the Supply Management Team (SMT) and Pump Order Services (POS) teams by working assigned tasks within service level agreements.

Utilize the system, and/or contact the patient to obtain basic policy, plan and group numbers for all insurance carriers on the patients account to confirm eligibility.

Interact with insurance carriers/patients/websites to conduct comprehensive insurance benefit verifications for all insurance carriers with confirmed eligibility on the patients account.

o For all Medtronic products, determine the appropriate coverage category, i.e. DME, pharmacy, both or non-covered.o Identify any medical policy requirements for coverage, i.e. pre-existing, lab requirements, office visits, blood glucose logs, etc.o Obtain all necessary information to estimate patient out of pocket liability, i.e. deductible amount, deductible met, co-pay/co-insurance, coordination of benefits, and DME cap.o Obtain referral / authorization requirements down to the HCPCS level, including dollar threshold and utilization limitations.Document insurance eligibility and benefits within the customer account, using appropriate note standardization and document management policies, to ensure accurate and timely billing for current and future customer orders.

Collaborate with internal and external customers to assist our patients with questions on obtaining Medtronic products, therapy, troubleshooting, health insurance coverage concerns, transferring patients to the appropriate department as needed.

Meets or exceeds key performance indicators measuring productivity, quality, and service level as defined by Senior Management.

Actively participates in team initiatives and in team status meetings.

Additional team activities, projects, and work flow as assigned.

Service Excellence:

o Works to identify ways to initiate processes that work towards enhanced revenue cycle outcomes, and improving service levels to both internal and external customers.o Actively participates in process and service improvement activitieso Encourages and supports staff members in the pursuit of service excellenceMust Have: Minimum RequirementsTO BE CONSIDERED FOR THIS ROLE, PLEASE BE SURE THE MINIMUM REQUIREMENTS ARE EVIDENT ON YOUR RESUMEMinimum of 2 years of relevant experience

High School Diploma or equivalent required

Nice to HaveExperience understanding medical policy information, utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms.

Experience with medical billing and collections terminology CPT, HCPCS and/or ICD-9 coding.

Experience with HIPAA guidelines and healthcare compliance.

Good customer service skills with ability to interact with both internal and external customers, i.e. patients, insurance payors, doctors, internal departments, and handle in a professional manner with customer-friendly focus and attention to detail in resolving issues.

Ability to maintain composure, and to follow instructions and protocols when dealing with unfamiliar or unusual payor/customer issues.

Demonstrate ability to present information in a clear, concise, and grammatically correct manner both verbally and in writing.

Demonstrate collaboration skills (including active listening skills, presentation skills) and proven ability to work effectively in a diverse, inclusive organization and environment.

Demonstrate ability to accept and carry out oral and written instructions accurately.

Demonstrate ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment.

Ability to prepare forms, spreadsheets, and graphs.

Experience in a payor or medical provider community that deals with all aspects of the revenue cycle.

Experience in a large corporate (even matrixed) environment.

Previous work experience with GE Centricity.

Previous experience in receiving and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities.

Proficiency in navigating multiple screens and programs at the same time in order to facilitate problem solving, and other activities that require multi-tasking.

About MedtronicTogether, we can change healthcare worldwide. At Medtronic, we push the limits of what technology, therapies and services can do to help alleviate pain, restore health and extend life. We challenge ourselves and each other to make tomorrow better than yesterday. It is what makes this an exciting and rewarding place to be.We want to accelerate and advance our ability to create meaningful innovations - but we will only succeed with the right people on our team. Lets work together to address universal healthcare needs and improve patients lives. Help us shape the future.Physical Job RequirementsThe physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. For Office Roles: While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to interact with a computer, and communicate with peers and co-workers.It is the policy of Medtronic to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Medtronic will provide reasonable accommodations for qualified individuals with disabilities.