Insurance Verification Specialist jobs in San Jose, CA

Planned Parenthood Mar Monte seeks an experienced and collaborative leader to serve as its Insurance Verification Manager. Reporting to the Director of Medical Billing, the Insurance Verification Manager manages the daily activities of the Insurance Verification team to ensure high quality customer service and improve revenue cycle activities for prior authorization, documentation, billing and claims.   

• Provides supervision, oversight, and direction to the insurance verification specialists, including, but not limited to, assignment allocation, training, employee motivation, and work performance evaluations.
• Hiring and onboarding of new team members, overseeing time off requests and timesheets, and ensuring adequate coverage during business hours.
• Review and create work queues and workflows for the Insurance Verification Specialists.
• Create new and review current policies and procedures, recommend areas of improvement to Eligibility and Benefits workflows, and coordinate with the Director of Medical Billing to implement changes as required.
• Monitor calls to ensure conformity to department procedures, policies, and guidelines, provide feedback, and mentor staff.
• Prepare and analyze monthly productivity reports, including insurance verification, authorization, and various patient tracking reports, to ensure correct benefits are documented in patients' charts.
• Ensure that the activities of the verification and authorization operations are conducted in a manner that is consistent with overall department protocol and in compliance with Federal, State, and payer regulations, guidelines, and requirements.
• Provide, oversee, and/or coordinate training for new and existing staff on workflows, policies, procedures, rules, regulations, etc.
• Review monthly denials related to insurance verification and, under the guidance of the Director of Medical Billing, take appropriate actions to eliminate insurance benefit-related denials.
• Spot audit benefit documentation, calls, and complete oversight of the authorization process. Provides continuous written and verbal feedback to staff and management regarding audit outcomes.
• Assigns and delegates tasks as needed in the absence of employees so workflow is maintained
• Facilitates and communicates necessary changes to appropriate department leadership to improve processes.
• Assist staff with patient service and insurance service issues.
• Maintains up to date working knowledge of latest healthcare trends in authorization, insurance verification and benefits, reimbursement, and claims denials.
• Conduct research necessary to update reference materials
• Assist in completing annual and ongoing audits
• Performs other duties as assigned.

• Five or more years of call center and insurance verification experience.
• Two years of supervisory/management experience.
• High volume phone queue experience
• Prioritize and delegate effectively to achieve high standards of productivity and quality.
• Knowledge of medical insurance (HMO, PPO, EPO, etc) and authorization processes.
• Strong communication and organizational skills.
• Strong analytical and problem-solving skills.
• Excellent written and oral communication skills.

• Bilingual in English and Spanish preferred
• Experience in creating training materials to educate and cultivate staff
• Must adhere to all HIPAA guidelines and regulations and maintain patient and organization confidentiality.