Insurance Verification Clerk Job at Vitreous-Retina-Macula Consultants of New York PC, New York, NY

aW5hc0JkMFpZQ0ljU005QUFQdFVIL3pPRUE9PQ==
  • 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

TJX Companies, Inc.

Customer Experience Coordinator Job at TJX Companies, Inc.

 ...environment is ever-evolving - and always encouraging. Every shift is a new opportunity to Discover Different. Posting Notes: HomeGoods Store 0011 || 107 E. Swedesford Rd., Suite 100 || Exton || PA || 19341 Opportunity: Contribute To The Growth Of Your Career.... 

U.S. Army

Aircraft Mechanics and Service Technicians (94R) Job at U.S. Army

 ...equipment. This is not a civilian contractor position. No experience necessary. Position is entry level. REQUIREMENTS:...  ...Score: Electronics (EL) SKILLS YOU'LL LEARN: Mechanical Maintenance Aircraft Procedures Electronic & Mechanical BENEFITS:... 

Thompson Denver

Housekeeper / Room Attendant Job at Thompson Denver

Summary When you stay at the Thompson Denver, you are welcomed as a resident. With intuitive service, each guest is provided a tailored experience, enhancing personal travel journeys and bridging connections to the local perspective. Thompson Hotels are located in timeless...

chevron

Gas Station Attendant Job at chevron

 ...a reliable and customer friendly Gas Station Attendant to join our team! Gas Station Attendant Needed for Night Shift - Free Accommodation Included! Responsibilities: Assist customers with fuel and store purchases.Operate the cash register and handle transactions... 

TENTH MOUNTAIN LLC

Entry-level Recruiter (100% Commission - Contract 1099) Job at TENTH MOUNTAIN LLC

 ...Part-time Entry-level Recruiter (100% Commission - Contract 1099) Job Description We are looking for a part-time entry-level recruiter to join our team. The ideal candidate will be highly motivated and have a passion for helping people find jobs. You will be responsible...