Under the direction of the Controller, the FQHC 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 or setting.
Highly proficient in spreadsheet software such as Microsoft 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.
Ability to use office productivity tools such as Google search engine, email, scanner, etc.