Insurance Verification Representative

Overview

Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an attentive listener, fast-thinker, and problem-solver, with the ability to relate to different people, you are a match for CCS. As a Verification Representative, you’ll be at the heart of our operations as you deliver first-class customer service in every interaction in our call center. You will be responsible for qualifying patients’ insurance coverage and ensures patient orders are accurate and complete prior to shipment claim. The verification representative will verify coverage for governmental, commercial insurance companies and patient accounts. You’ll be the one of our subject matter experts that will help us solve our patient’s challenges-and deliver on our promise of superior customer service. Alaska, California, Colorado, Delaware, Hawaii, Idaho, Maine, Montana, Nevada, New Hampshire, New York, North Dakota, Rhode Island, South Dakota, Vermont, Washington, Wyoming , Illinois; residents are not eligible.

Responsibilities

• Makes outbound calls to insurance companies to verify insurance benefits
• Evaluates insurance coverage in order to determine the policy’s compatibility with our program and recommends the appropriate products based on the patient’s needs and insurance coverage
• Efficiently and accurately verifies, reviews, documents and completes insurance verifications
• Identifies and initiates documentation needs and requests to permit timely billing of services and communication with appropriate team(s)
• Reviews patient accounts and determines appropriate action(s) needed to collect payment
• Reviews claims and performs claim corrections and submissions to new carrier based on new plan verification
• Has a strong working knowledge of billing procedures, insurance reimbursement procedures and HCPC codes
• Ability to analyze and correct accounts receivable problems
• Maintains a high degree of confidentiality always due to access to sensitive information
• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
• Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements

Qualifications

• High School diploma
• One-year medical insurance verification related experience or equivalent combination of education and experience
• One year of customer service experience required
• Has a strong working knowledge of billing procedures, insurance reimbursement procedures and HCPC codes
• Ability to analyze and correct accounts receivable problems
• Proficient in Microsoft Outlook, Word, Excel, PowerPoint and computer literacy
• Knowledge of government and commercial insurance payers as it relates to documentation of claims that are required before submission
• Ability to understand Medical Records documents
• Position may require evening and weekend availability

Values Certainty-The lives of the individuals we serve depend on our ability to execute. We commit to doing this every day.

• Use appropriate methods and a flexible interpersonal style to help build a cohesive and collaborative team based on a foundation of trust and transparency. Deliver what you commit to.

Compassion-We understand the burdens of patients and their loved ones and channel this into a relentless pursuit of customer satisfaction in every part of our business.

• Ensure that the patient is the driving force behind business decisions, implementing service practices that meet needs of both the patient and the organization. Treat others the way you want to be treated.

Advancement-We are endlessly looking for ways to progress and become more innovative in all things we do.

• Encourage innovative approaches for addressing opportunities and facilitating change, driving cross-functional alignment to accomplish goals. Speak the truth.

CCS Medical and EEOC/AA employer. M/F/D/V Company Overview CCS is the strategic partner addressing America's most pressing healthcare challenges through intelligent chronic care management, tackling the $412 billion annual diabetes burden and chronic conditions affecting over 133 million Americans. At the core of CCS's differentiated model is LivingConnected®, a human-led, digitally-enabled clinical solution. PropheSee™—an AI-powered predictive model that identifies non-adherence risk and delivers personalized interventions— is an integral part of this solution, creating a first-of-its-kind platform to improve adherence, enhance clinical outcomes, and help prevent costly hospitalizations. By combining data-driven insights with three decades of industry relationships, CCS is the smart choice for health plans, providers, employers, and manufacturers who believe that value-based care starts by keeping patients healthy and delivers benefits like lower cost of care, improved HEDIS scores, and alleviating provider burnout. CCS's approach extends clinical reach while supporting over 200,000 people nationwide with home-delivered medical supplies and pharmaceuticals annually. Recognized as a Great Place to Work®, and with numerous peer-reviewed publications validating our care management approach, CCS is more than a trusted supplier—we're a partner in transforming chronic care delivery. To learn more about how CCS is addressing today's healthcare challenges, visit ccsmed.com or connect with us on LinkedIn.

What We Offer

• Competitive Salary
• Bonus/Incentive Opportunities/commission: (if applicable)
• Comprehensive Benefits:
• Medical, dental, and vision insurance
• 401(k) with company match
• Paid time off (vacation and holidays)
• Growth & Development:
• Ongoing training and professional development
• Work-Life Balance:
• Remote or hybrid work options (if applicable)
• Wellness programs and mental health support