Insurance Analyst

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Requirements:

• 3-5 years of direct experience in insurance verification within a hospital, outpatient facility, or physician practice setting.
• Experience screening, hiring, and managing teams of 2+, with a track record of meeting KPIs.
• Proven experience in analyzing large data sets to drive strategic decisions.
• Experience managing third-party vendors or partners.
• Strong knowledge of healthcare topics, including insurance products, ICD-10 billing, CPT codes, and EHR systems.
• Strong understanding of prior authorization processes.
• Proficiency in online insurance portals such as Navinet, Availity, etc.
• Advanced proficiency in Excel/Google Docs.
• Experience with SQL is a plus.
• Effective communication skills, with experience using Slack/Teams for team collaboration.

Responsibilities:

• Aggregate & analyze data to identify areas for improvement in insurance verification process
• Work with internal teams including product & engineering to build & optimize features in proprietary CRM
• Produce clear documentation to align teams and communicate complex workflows effectively.
• Own & manage vendor relationships for manual insurance checks. Lead new implementations and ensure seamless expansion as we onboard new partners.
• Handle escalations and communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
• Review and validate patient insurance information, ensuring accuracy in billing and demographic details. Determine member benefit coverage for treatments and procedures.
• Build process to submit prior authorizations from insurance companies.
• Hire a team of insurance verification specialists, providing coaching and performance feedback to ensure high standards of insurance verification quality and accuracy.
• Manage training for team roles, maintaining alignment with operational goals and KPIs.
• Communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
• Support cross-functional collaboration by sharing insurance authorization and appeals processes with providers and assisting the scheduling team.
• Analyze and optimize outreach methods to improve patient engagement, collaborating with Product & Engineering teams to refine technical workflows.
• Develop best practices and evaluate key performance indicators (KPIs) for the insurance verification process.