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

American Surplus Inc.

Conveyor Mechanic Job at American Surplus Inc.

 ...~ Thoroughly inspect incoming used conveyor systems and components to identify wear...  ...Refurbishment and repair: ~ Perform mechanical and electrical repairs, including replacing...  ...with upgrades, modifications, and installations as needed for specific systems being prepared... 

Pacific Seafood

Route Delivery Driver Job at Pacific Seafood

 ...Productivity, and Excellencewhich means consistently doing your best and always striving to do better. Summary: The Route Delivery Driver at Pacific Seafood is a key role on our Transportation team supporting efforts to maintain operational efficiency, enhance... 

One Behavioral

Mental Health Medical Assistant Job at One Behavioral

 ...Medical Receptionist role: Reporting to the Provider, the Medical Assistant will be the first point of contact for all patient inquiries. The successful candidate will be able to multitask and have the necessary skills to work in a fast paced environment. Job Description... 

Dependable Cleaning Company

Professional Home Cleaner Job at Dependable Cleaning Company

 ...Dependable Cleaning Company is seeking hardworking and reliable home cleaners to join our team. As a local business, we provide cleaning services to clients in the Northern Virginia area. This position is an independent contractor cleaning position. As a contracted cleaner... 

Care Solutions, Inc.

Nurturing Nanny Needed Job at Care Solutions, Inc.

 ...Full time, experienced Nanny to care for 2 children in their Newtown Square home. Hours are Monday through Friday from 8:00 am to 5:00 pm. Since Mom is expecting a new baby, Nanny will need infant experience. Nanny needs to be nurturing and also very energetic to engage...