Summary
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.