Insurance Verification Clerk

USPI•Suffolk, VA

3d•Onsite

About The Position

Bon Secours Surgery Center at Harbour View is seeking a detail-oriented and customer-focused Full-Time Insurance Verification Clerk to join our Business Office team. We are a busy, multispecialty ambulatory surgery center serving the Northern Suffolk community and are affiliated with United Surgical Partners International (USPI). The Insurance Verification Clerk plays a critical role in the revenue cycle and patient experience by ensuring accurate insurance verification, eligibility determination, benefits review, and authorization support prior to scheduled procedures. This position works closely with physician offices, patients, insurance carriers, and internal clinical and administrative teams to ensure accurate financial and demographic information is obtained and documented, helping facilitate a seamless and positive surgical experience. Under the direction of the Business Office Manager, the Insurance Verification Clerk supports the center's operational, financial, and patient satisfaction goals while maintaining compliance with all facility, regulatory, and payer requirements.

Requirements

High School Diploma or GED required.
Minimum of 2 years of experience in insurance verification, patient access, medical billing, registration, or related healthcare revenue cycle functions.
Strong knowledge of commercial insurance plans, Medicare, Medicaid, managed care organizations, and workers' compensation benefits.
Experience verifying insurance eligibility and benefits through payer portals, clearinghouses, and direct payer contact.
Excellent verbal and written communication skills.
Strong organizational skills with exceptional attention to detail and accuracy.
Ability to effectively prioritize multiple tasks in a fast-paced healthcare environment.
Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and Teams.
Ability to maintain confidentiality and professionalism while handling sensitive patient information.

Nice To Haves

Ambulatory Surgery Center, hospital, or medical practice experience.
Medical terminology knowledge preferred.
Understanding of CPT, ICD-10, and authorization requirements.
Knowledge of insurance reimbursement methodologies and managed care contracts.
Demonstrated longevity and stability in previous employment.

Responsibilities

Verify insurance eligibility, benefits, deductibles, co-insurance, out-of-pocket maximums, and coverage limitations for scheduled surgical procedures.
Obtain and document accurate patient demographic and insurance information within the facility's practice management system.
Review scheduled procedures to determine authorization and referral requirements.
Coordinate with physician offices and insurance companies to secure required authorizations and ensure timely approval before services are rendered.
Communicate with patients regarding insurance coverage, anticipated financial responsibility, payment expectations, and required documentation.
Review Explanation of Benefits (EOBs), managed care contracts, and payer guidelines to ensure accurate interpretation of coverage and reimbursement requirements.
Research and resolve insurance discrepancies, eligibility issues, and authorization challenges.
Maintain detailed and accurate records of verification activities and payer communications.
Assist with patient registration duties as needed, including updating demographic information and obtaining required signatures and documents.
Support collection efforts by identifying patient financial responsibility and communicating payment expectations prior to surgery.
Collaborate with Business Office, Clinical Leadership, Scheduling, and Physician Office personnel to ensure efficient patient throughput and outstanding customer service.
Maintain compliance with HIPAA regulations and all facility policies related to patient confidentiality.
Stay current on payer requirements, insurance regulations, and reimbursement trends affecting ambulatory surgery centers.
Participate in process improvement initiatives designed to enhance operational efficiency and patient satisfaction.