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

Fiserv

Military Pathways - Project Manager Job at Fiserv

 ...Calling all innovators - find your future at Fiserv. We're Fiserv, a global leader in Fintech and payments, and we move money and information in a way that moves the world. We connect financial institutions, corporations, merchants, and consumers to one another... 

Southern Glazer's Wine & Spirits

Inside Sales Consultant - Addison, TX Job at Southern Glazer's Wine & Spirits

 ...Employers for Diversity. Compensation: We offer $22.00 per hour + sales performance plan, providing the opportunity to earn incentives...  ..., tax-saving Flexible Spending Accounts, disability coverage, life insurance plans, and a 401(k) plan. We also offer tuition reimbursement,... 

UBS

Real Estate Asset Analyst - Commercial Job at UBS

 ...Your role Are you a real estate expert with strong negotiation skills? Have you got a track...  ...a portfolio of approximately 12 to 16 Commercial and Industrial investment properties. Key...  ...plans and tracking key property-level financials; maintain and update ARGUS... 

Griswold Home Care for Westminster, Broomfield & Boulder

Caregiver for Weekends Job at Griswold Home Care for Westminster, Broomfield & Boulder

Weekend Caregivers NeededLocation: Broomfield and Boulder County (Boulder, Louisville, Lafayette, Longmont, Erie etc.)Shifts: Friday, Saturday, and Sunday, 6 AM - 10 PMCompensation: $18 - $21 per hour based on experience, willingness to drive and availabilityDescription... 

ARDAGH GROUP

Overhead Crane Operator 10 Job at ARDAGH GROUP

 ...Role Description: The Briquetter/Overhead Crane position operates the baler and the overhead crane. Operates industrial truck to perform transportation assignments in designated locations according to prescribed method. Identify and transport material to and from...