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

NP Now

OB/GYN -#1 TX group Job at NP Now

 ...overall compensation package . Community Description: Year-round outdoor activities include golfing, hunting, fishing, camping, hiking, boating Excellent public and private schools Excellent family community, great sports, humble people, top schools,... 

Online Marketing Gurus

Remote SEO Copywriter Job at Online Marketing Gurus

 ...-led copywriter, you will have the required skills, ability and work ethic to create polished, high-quality copy on deadline for a wide...  ...who is talkative and wants to learn on the go This is a remote (work from home) role but candidate must be located in the Philippines... 

ExecutivePlacements.com

Data Scientist Intern (Remote) Job at ExecutivePlacements.com

 ...and operated by Scale AI , weve recently been featured in Forbes for partnering experts with top AI labs to provide the high quality data for LLMs. We believe AI can only perform as well as the data its trained on. Thats why we work with contributors from all over the... 

ShadowBox LLC

Biomedical Research Associate Job at ShadowBox LLC

 ...QUALIFICATIONS: Education ~ The Biomedical Research Associate shall have at a minimum a Masters degree in basic biomedical research field (to include, but not limited to biology, chemistry, zoology, microbiology) or a minimum of 10 years demonstrated experience in... 

Aquacare & Fitness Forum Physical Therapy

Physical Therapy Tech- Annapolis MD Job at Aquacare & Fitness Forum Physical Therapy

 ...enthusiastic Exercise Specialist/Rehab Tech to join our team in Annapolis, MD. In this...  ...under the supervision of a licensed Physical Therapist. You will also ensure the safety...  ...being of patients and staff during aquatic therapy sessions. Key Responsibilities: Guide...