Insurance Liaison

Summary

Under the direction of the Controller, the Insurance Liaison plays a crucial role in fostering communication and collaboration between the Federally Qualified Health Center (FQHC) and various insurance providers. This position is responsible for managing insurance-related processes, verifying patient coverage, and ensuring accurate billing and reimbursement.

Essential Duties and Responsibilities

• * Insurance Verification:

• -Verify patients' insurance coverage and eligibility.

  - Collaborate with patients to obtain necessary insurance information.

  - Update and maintain accurate insurance records.

• * Billing and Coding:

• -* Work closely with billing and coding staff to ensure accurate claims submission.

  -* Review claims for completeness and accuracy before submission.

  -* Address any insurance-related issues emerging during the billing process.

• * Communication with Insurance Providers:

• -* Establish and maintain strong relationships with insurance company representatives.

  -* Regularly communicate with insurance representatives accordingly.

  -* Stay informed about changes in insurance policies and procedures.

• * Patient Education:

• -* Provide patients with information regarding their insurance coverage and benefits.

  -* Assist patients in understanding and navigating the insurance process.

  -* Address patient inquiries related to insurance matters.

• * Claims Resolution:

• -* Investigate and resolve insurance-related claim denials and/or rejections by means of the worklog.

  -* Work proactively to prevent claim denials through accurate documentation and communication.

• * Maintains all passwords for the Managed Care/Third Party carriers who allow verification via provider websites.
• * Maintains confidentiality of all information/adheres to all HIPPA guidelines/regulations.
• * Responsible for ensuring external and internal telephone calls are answered in a professional and timely manner in accordance with department policies, procedures, and performance goals.
• * Perform other duties that may be assigned by Controller.

• Requirements/Qualifications

• * High school diploma or General Education Degree (GED)
• * Preferred minimum of three (3) years' experience in one or more of the following: Medical/ Dental Coding Certification and/or knowledge of Current Medical Terminology (CMT), Current Dental Terminology (CDT)
• * Relevant work experience in a medical or dental office setting.
• * Higher level knowledge of Excel
• * Ability to effectively communicate both verbally and in writing. Additionally, establish and maintain effective working relationships with employees, departments, and the public.
• * Ability to work independently and with a team to obtain objectives.

• •* Proficient in office productivity tools such as Google, email, scanner, etc.