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

Harris Health and Rehab

LPN Charge Nurse Job at Harris Health and Rehab

 ...primary purpose of your job position is to supervise the day-to-day nursing activities of the facility during your tour of duty. Such...  ...the residents admission, transfer, and/or discharge. Receive telephone orders from physicians and record on the Physicians Order Form... 

Mayo Clinic

Social Worker - MSW, LGSW, LICSW Job at Mayo Clinic

 ...to succeed. The Mayo Clinic Section of Social Work has various positions available in...  ...settings. The role of an inpatient social worker at Mayo Clinic is to assess and support...  ...consideration: CV/Resume Cover Letter Internal candidates must also attach their three... 

CALUMET COUNTY

Park Building Attendant (Seasonal) Job at CALUMET COUNTY

 ...building custodial activities. Assists in office duties including, but limited to telephone and reception; maintaining records registering park users, preparing reports and completing forms; and photocopying documents. Gives information regarding departmental activities or... 

Cloud Analytics Technologies LLC

ETL Data Platform Developer Job at Cloud Analytics Technologies LLC

 ...Summary Role : ETL Data Platform Developer Location : Redmond, WA (Onsite ) Key Responsibilities Design and implement ETL pipelines using Microsoft Fabric (Dataflows, Pipelines, Lakehouse ,warehouse, sql) and Azure Data Factory. Build and maintain a metadata... 

A Igreja de Jesus Cristo dos Santos dos Últimos Dias

MTC Training Desk Assistant (Part-time) Job at A Igreja de Jesus Cristo dos Santos dos Últimos Dias

View More Jobs MTC Training Desk Assistant (Part-time) Provo, UT, United States To meet the needs of the Church, we seek to build...  ...staff at various levels in all departments across the MTC Attends meetings in absence of Supv, Training Operations Coordinator...