Verification Specialist

Just a few of the Benefits enjoyed by PPIL employees…

-Company subsidized premiums on Medical, Dental, and Vision Insurance

-Up to 12 weeks Paid Parental Leave for eligible employees

-Generous Paid Time Off (PTO) and paid holidays

-Mission focused work

-401k with employer matching

-100% company-paid Life Insurance

-100% company-paid Short- and Long-Term Disability Coverage

-Robust Employee Assistance Program

-Professional Development awards and opportunities

-Flexible Spending Accounts

-Free Medical Services at PPIL

-Pet Insurance

The Verification Specialist identifies third-party insurance coverage, answers billing questions, and performs other administrative duties as required. Striving to achieve reconciled patient balances, the Verification Specialist focuses on actions to prevent unpaid claims at the point of service. This position works under the supervision of the Manager of Enrollment & Verifications.

Essential Functions:

1. Verify patient third-party insurance coverage and update patient accounts. Whenever feasible, employs the use of on-line payer websites to facilitate timely and quality verification of benefits and eligibility.

2. Act as a liaison to health center staff regarding billing questions as well as any changes health center staff need to make to a patient’s account to ensure acceptance of a claim.

3. Will attempt phone contact with patients whose verification detected coverage concerns.

4. Ensure all data entered at health centers meets applicable third-party guidelines as well as the software guidelines for electronic submission.

5. Adhere to all departmental policies and procedures, including established HIPAA privacy and security procedures.

6. Through these activities demonstrate an understanding of and commitment to PPIL core values of respect, knowledge, responsibility, health, compassion and access; practice these values in relations with internal and external customers. 

Other Responsibilities:

1. Verify insurance coverage for appointments and add-on appointments that are received from health centers via tickets or other methods.

2. Communicate in a timely manner with the Health Center Manager regarding any problems that may prevent the verification of insurance or payment of services.

3. Processes credit card payments via phone or in person, constantly striving to resolve outstanding balances.

4. Correct posting errors or adjustments to patient files as needed. 

5. Will provide updated information to PAS and Billing staff during weekly ‘Checkpoint’ meetings.

6. Assist the billing department in remaining current with insurance verification trends.

7. Communicate with the IT Department regarding any technical problems that may prevent the submission of data in a timely manner. 

8. Clerical duties, including but not limited to: filing, typing, forms rotations, copying, answering calls and voicemail, and other duties as assigned.

Performance Measurement:

Quality Goals

- 97% of all accounts verified shall be deemed correct and fully complete.

- Appropriate use of on-line payer websites to ensure quality EBV processing.

Productivity Goals

- Ability to process 100% of the required verifications as identified on the “Daily Report”.

- Ability to accurately process and identify fast-track versus traditional verification types.

- Ability to process 100% of the ticket inquiries identified on the “Dashboard”.

- Timely submission of the tally log identifying the number of verifications completed.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, stand, walk, talk, and hear. The employee frequently is required to use hands and fingers to key in data, handle, or feel and reach. The employee must occasionally lift and/or move up to 10 pounds. General medical office environment, noise level is usually low. Will be working with general 

office equipment, including computers, phones, and printers.

Supervisor: Manager of Revenue Cycle Integrity.

Status: Full-time. Non-exempt from the overtime provisions of the wage and salary regulations.

• Minimum completion of an accredited high school program or equivalent. Some college preferred.

• Minimum two years billing experience, preferably in a not-for-profit environment. 
• Minimum two years medical billing experience with a computerized billing system.
• Insurance verification and/or patient access experience preferred.
• Strong knowledge of CPT and ICD-10 billing codes.
• Working knowledge of computer spreadsheets and word-processing.
• Strong organizational skills; accurate and detail-oriented, especially with data entry.
• Good written and oral communication skills and the ability to meet strict deadlines.
• Ability to work well both with others and independently and to respond with sensitivity to clients, staff, and volunteers. 

Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We know that BIPOC and women identifying candidates are less likely to apply to jobs unless they meet every requirement. Please do not be deterred if your past experience doesn’t align perfectly with every qualification in the job posting. We encourage you to apply anyway! You may be exactly who we are looking for!