Insurance Verification Clerk Job at Vitreous-Retina-Macula Consultants of New York PC, New York, NY

RXJHWUN3U0tKMjRXd21EMnlJNjlkWHRxQ0E9PQ==
  • Vitreous-Retina-Macula Consultants of New York PC
  • New York, NY

Job Description

  • Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
  • Insurance Verification determine if Participating in net work or out of Network- confirmed Members Benefits for services being rendered
  • Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
  • Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
  • Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
  • Coordinates with Providers and Members regarding authorization requests and/or activities
  • Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
  • Reviews all authorization requests for accuracy and prioritizing based on urgency
  • Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
  • Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
  • Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
  • Performs other duties and special projects, as assigned


Experience Requirement: 

  • Entry Level  willing to train

Preferred Qualifications:

  • Knowledge of CPT and ICD9/ICD10 coding/ Clinical.
  • Understanding of insurance plans, i.e. HMO, POS, PPO
  • Knowledge of Excel and Word
  • Excellent Organizational Skills; Attention to Detail
  • Exceptional Communication Skills
  • Working Knowledge of Insurance Company Operations and Procedures
  • Excellent customer service skills
  • Ability to prioritize work in a fast-paced environment
  • Computer skills
  • Appeals/Retro active request skills
  • Sending Specialty Prescription when needed 
  • MRI Authorization Utilization Management 
  • Knowledge of Manufacture Co-Pay Assistance Program/Foundation. 

Benefits:

  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • Life Insurance
  • 401k
  • 401k  matching
  • Flexible Spending Account
  • Aflac
  • Optum Transit
  • Paid time off
  • Parental Leave

Job Tags

Full time, Flexible hours,

Similar Jobs

Stafford Gray

Data Warehouse Architect - Senior ETL/BI Developer Job at Stafford Gray

 ...Position Overview The Senior Data Warehouse ETL/BI Developer is responsible for designing, developing, enhancing, and maintaining enterpriselevel data warehouse applications within a largescale Teradata environment. The role supports complex data initiatives across... 

Aloft New York Downtown Financial District

Area Chief Engineering Job at Aloft New York Downtown Financial District

**Job Title: Engineer Manager****Location:** [Location]**Job Type:** Full-Time **About Us:** We are a forward-thinking organization dedicated to innovation and excellence. Our team is passionate about delivering high-quality engineering solutions that meet the demands... 

Royal Star Realty

Data Entry Clerk Job at Royal Star Realty

 ...a detail-oriented and dependable Remote Data Entry Clerk to support our administrative and...  ...Process forms, documents, and reports in a timely manner Follow data confidentiality and...  ...Job Details Job Type: Full-Time or Part-Time Work Location: Remote (Work from... 

Randstad Technologies

UX Writer/Content Strategist Job at Randstad Technologies

 ...type: Contract salary: $55 - 56 per hour work hours: 8am to 5pm education: Bachelors Responsibilities Write and edit UX copy for web and mobile experiences, including navigation, user flows, and transactional content. Translate complex financial concepts... 

Electric Boat

Nuclear Test Electrical Engineer Job at Electric Boat

 ...Responsibilities for this Position Nuclear Test Electrical Engineer US-CT-Groton Job ID: 2025-15791 Type: Full-Time # of Openings: 2 Category: Engineering EB Groton Shipyard Overview The candidate for Test Engineer I/II/Sr/Spec will work...