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

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... 

Fleet Services by Cox Automotive

Mobile Diesel Mechanic II - Class C License Job at Fleet Services by Cox Automotive

 ...while your application is being reviewed, please Text DFS2 to (***) ***-****. Veterans encouraged to apply. Fleet Services A Cox Automotive Company keeps your fleet moving! Headquartered in Indianapolis, Fleet Services by Cox Automotive has grown to become one... 

Dynamics ATS

Electrical Technician Job at Dynamics ATS

 ...Houston, TX Type of Employment Contract-to-Hire Employer Info Our client is a manufacturer specializing in subsea pipeline components and forged products. Job Summary This position is responsible for working in a manufacturing environment to... 

Trinity Employment Specialists

Industrial Setup Mechanic Job at Trinity Employment Specialists

 ...for interview tips and many job opportunities! * Repair, install, adjust, or maintain industrial production and processing machinery or refinery and pipeline distribution systems. May also install, dismantle, or move machinery and heavy equipment according to plans.

The Center for Environmental Medicine & Occupational Health

Travel Nurse - NICU Job at The Center for Environmental Medicine & Occupational Health

We are seeking a dedicated Travel Nurse for NICU (Neonatal Intensive Care Unit) in Temecula, CA. Provide specialized nursing care to critically ill newborns and infants in a fast-paced environment. Monitor vital signs, administer medications, and assist with procedures...