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.