7.24.24
Insurance Verification Associate
About Us
God’s Love We Deliver, a nonsectarian organization, is the New York metropolitan area’s leading provider of life-sustaining meals and nutrition counseling for people living with severe illnesses. Begun as an HIV/AIDS service organization, today God’s Love provides for people living with more than 200 individual diagnoses. God’s Love cooks and home delivers the specific, nutritious meals a client’s severe illness and treatment so urgently require. Meals are individually tailored for each client by one of our Registered Dietitian Nutritionists, and clients have access to unlimited nutrition counseling. God’s Love supports families by providing meals for the children and senior caregivers of our clients. All of our services are provided free of charge to clients.
About the Role:
God’s Love We Deliver continues to be synonymous with healthcare and as our services expand, we continue to establish new and innovative partnerships with managed care and clinical providers. The Business Development and Community Partnerships Department establishes partnerships and contracts with hospitals, managed care providers, health systems, and community-based organizations. The Insurance Verification Associate is responsible for supporting the organization’s efforts to consistently monitor the eligibility of an increasing number of healthcare members. The role works closely with both our Healthcare Partnerships and Finance Departments to confirm that individuals served are eligible for billable services under our contractual relationships with managed care organizations and health systems. The position is integral to supporting the team’s effort to increase and maintain the number of clients needing medically tailored home-delivered meals. To accomplish these goals, the role provides specific administrative support to the enrollment and overall engagement process, maintains strong relationships with partners, and collaborates with both internal and external partners.
- Benefits: Excellent Health, Dental, and Vision insurance at low cost to employees. Option to enroll in pre-tax Commuter Transit, Flexible Spending Account, and Health Savings Account.
- Retirement Savings Plan: 403B with up to a 2% match each pay period
- Paid Time Off including
- 15 Days of annual Paid Vacation Time Off in first year of employment, increasing with length of service
- 12 days of annual Paid Sick Time
- 10 paid holidays
- Monday through Friday.
- A rewarding work environment: Supporting our operations providing nutritious meals to New Yorkers living with severe illness.
- A collaborative work environment: Everyone works together to contribute their talents and their ideas.
- A fun work environment: Periodic staff lunches and Happy Hours; an annual staff retreat to focus on team learning and team-building; a fun Holiday Party to celebrate our staff
- An inclusive work environment: Celebrating diversity, equity and accessibility, valuing the unique perspectives and life experiences that all employees bring to work.
- This is a hybrid position allowing for some remote work and requiring regular in-office workdays.
- This is a Full-Time exempt position, paying $65,000 – $70,000 annually.
Essential Duties and Responsibilities:
- Acts as liaison for cross-departmental work between the Finance, Healthcare Partners, and Business Development and Community Partnerships Departments.
- Responsible for timely and efficient assessments of the eligibility of authorizations received for services to be provided.
- Responsible for monitoring and the verification of eligibility of existing authorized clients throughout their service period for timely and accurate billing.
- Supports the Finance Department leadership, billing and coding teams to support proper coding and billing practices.
- Works with the Business Development (Healthcare) Manager and Chief Business Development Officer in addressing partner inquiries, providing eligibility updates to partners and ensuring client service engagement.
- Supports the Manager of Healthcare Partners and the Healthcare Partners team with authorization activities including initial data entry, data review, partner portal reviews.
- Responsible for immediate and timely notification of actionable discoveries to the Finance, Healthcare Partners, and Business Development and Community Partnerships departments.
- Engages and communicates with healthcare providers, managed care organizations, hospitals and other partners to gather required clinical information for authorization submissions and to ensure timely and accurate approvals.
- Submits prior authorization requests to managed care organizations and healthcare partners through various channels (phone, fax, online portals).
- Corrects authorizations and verification information when necessary. Maintain accurate records of all prior authorization activities and outcomes.
- Provides administrative support, including but not limited to generating reports to monitor enrollments for healthcare partner agencies, notifying partners of any discrepancies regarding client eligibility, and reporting findings with actionable items and tracked progress of eligibility verification efforts.
- Remains up to date with changes in insurance policies, guidelines, and procedures related to prior authorizations.
- Adheres to HIPAA regulations and always maintains patient confidentiality.
- Reviews records and authorizations for valid ICD-10 diagnosis codes, make appropriate requests from referring partners for encounters that may need to be reviewed for valid ICD-10 coding following compliance guidelines.
- Supports initiation and follow up efforts with authorization appeals.
- Answers incoming calls and inquiries regarding benefits, eligibility, denial responses and services provided.
- Meets with internal project teams regularly to ensure all deliverables are on track.
- Other duties as assigned.
About You:
You are highly driven, self-motivated, and empathetic, with a strong desire to provide support to clients living with a serious illness. You are detail-oriented, while communicating effectively across the organization. You are looking for a collaborative, team-oriented environment, and are energized by opportunities for collaboration.
In addition, you meet the following requirements:
- Bachelor’s degree
- Minimum of 3 years of fast-paced healthcare or nonprofit experience, ideally with an administrative and/or community engagement focus.
- Previous experience as a prior Authorization Specialist or in a similar role
- Possesses a Medical Coding Certification with strong knowledge of medical coding, managed care, and medical terminology.
- Previous experience with insurance verification processes and requirements.
- Proficiency in using electronic health record (EHR) systems and other relevant software applications
- Microsoft Office proficiency required; Excel expertise a must.
- Superior attention to detail.
- Must be able to operate effectively as part of a team and independently.
- Excellent communication skills, both written and verbal.
- Strong project management skills.
- Effectively communicates (verbally and visually) with internal and external stakeholders across all levels, with strong presentation skills.
- Superior time management skills with the ability to work effectively under deadlines and fluidly across priorities.
- Monday.com, Salesforce, EZ Claim or other billing software experience a plus
- Raiser’s Edge NXT experience a plus.
