Associate Insurance Verification Representative

SCA Health•UNAVAILABLE, UNAVAILABLE

About The Position

The Associate Insurance Verification Representative verifies patient insurance eligibility and benefits, obtains authorizations, documents insurance and authorization information in the patient accounting system, and communicates estimated patient financial responsibility and center policies. The role covers California facilities and is scheduled Monday through Friday from 11:30 a.m. to 8:00 p.m. Eastern / 10:30 a.m. to 7:00 p.m. Central / 8:30 a.m. to 5:00 p.m. Pacific. The representative works with physician offices, patients, insurance companies, payer websites, and center-selected vendors to ensure accurate insurance verification and authorization. Responsibilities also include checking payer policies and coverage, escalating out-of-network insurance, and helping patients understand financial obligations and required notices before their date of service.

Requirements

High school diploma or GED.
Strong customer service experience.
Previous insurance verification experience.
Previous experience calculating out-of-pocket expenses.
Healthcare experience.

Responsibilities

Confirm that sufficient information is available to verify insurance eligibility accurately, contacting physician offices or patients when needed.
Determine whether secondary insurance should be added to the patient account and ensure the correct primary payer is selected.
Use the center-selected vendor and/or payer websites to obtain eligibility, benefits, precertification, and authorization information.
Enter patient insurance information into the patient accounting system, selecting the appropriate payer and financial class.
Immediately notify the manager when a patient’s insurance is out of network and follow policies and procedures for accepting out-of-network payers.
Document insurance verification findings in the patient account and contact patients with estimated coinsurance, copay, and/or deductible amounts due on or before the date of service, as applicable.
Contact patients before the date of service to review physician ownership, advance directives, and patient rights in accordance with CMS Conditions for Coverage guidelines.
Obtain authorizations from insurance companies or physician offices and ensure accurate information, including the scheduled procedure, date of service, facility name, and authorization expiration status.
Enter authorizations in the patient accounting system, including procedure name/CPT codes and effective dates.
Ensure high-cost implants, supplies, or equipment rentals are included in authorizations.
Check insurance company approved-procedure lists and medical policies; notify patients when a procedure is not payable and obtain a signed Medicare ABN or other non-covered notification form if the patient chooses to proceed.
Calculate patient copays and estimated coinsurance according to the applicable payer contract and plan.
Obtain prior approval from the SCA Compliance Department before accepting in-network benefits for out-of-network payers.
Understand payer guidelines and processes for collecting point-of-service payments, deductibles, copays, and coinsurance, including Medicare, Medicaid, other government contracts, and workers’ compensation fee schedules.
Contact patients and communicate the center’s financial policy.