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

Lensa

Distribution Manager I Job at Lensa

 ...direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Northrop Grumman. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is... 

AIG

Finance Operations Analyst Job at AIG

Who we are American International Group, Inc. (AIG) is a leading global insurance organization. Building on 100 years of experience, today AIG member companies provide a wide range of property casualty insurance, life insurance, retirement solutions, and other financial...

Mangrum Career Solutions LLC

Commercial Title Insurance Underwriting Counsel Attorney - Hybrid (Miami) Job at Mangrum Career Solutions LLC

 ...transactions. This role is ideal for a commercial real estate attorney or experienced title insurance underwriter who enjoys applying legal analysis to real estate matters, solving problems in real time, and partnering with internal teams and clients to deliver best-in-... 

Bayer

Quality Generalist Job at Bayer

 ...At Bayer we're visionaries, driven to solve the world's toughest challenges and striving for a world where 'Health for all Hunger for none' is no longer a dream, but a real possibility. We're doing it with energy, curiosity and sheer dedication, always learning from unique... 

ITG Communications, LLC

HDD Locator Job at ITG Communications, LLC

 ...Job Description The HDD Locator will operate various types of locators including Subsite and Falcon. This position requires good knowledge of safely operating equipment around live utilities in the underground/telecom utility field. The candidate must have full knowledge...