Insurance Liaison

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.