Insurance Verification Representative - Northwest Florida Surgery Center

SCA Health•Panama City, FL

About The Position

The Insurance Verification Representative at Northwest Florida Surgery Center verifies patient insurance eligibility and benefits, obtains authorizations, documents findings in the patient accounting system, and communicates financial information and center policies to patients. The role requires coordinating with physician offices, patients, insurance companies, and internal teams to ensure insurance information and authorizations are complete and accurate before the date of service. The position also supports center compliance by contacting patients before their procedures to review physician ownership, advance directives, and patient rights.

Requirements

Healthcare experience is required.
Experience checking authorizations.
Experience with CPT codes.
Ability to work in a detailed, high-production environment.
Local to the area or within driving distance.

Nice To Haves

Bachelor’s degree preferred but not required.

Responsibilities

Verify that sufficient information is available to accurately check patient insurance eligibility, contacting physician offices or patients when needed.
Determine whether secondary insurance should be added to a patient account and ensure the correct primary payer is selected.
Use the center’s selected vendor and/or payer websites to obtain eligibility, benefits, pre-certification, and authorization information.
Enter patient insurance information in the patient accounting system with 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 before or on the date of service, as applicable, to communicate estimated co-insurance, copay, or deductible amounts due.
Contact each patient 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 the procedure, date of service, and facility name are included and the authorization has not expired.
Enter authorizations into the patient accounting system, including procedure names or CPT codes and the effective date of authorized procedures.
Confirm high-cost implants, supplies, or equipment rentals are included in authorizations.
Check insurer-approved procedure lists and medical policies; notify patients if a procedure is not payable and obtain a signed Medicare ABN or other non-covered notification form if the patient elects to proceed.
Calculate patient copays and estimated co-insurance due under applicable payer contracts and plans.
Obtain prior approval from the SCA Compliance Department before accepting in-network benefits for out-of-network payers.
Follow payer guidelines and processes for collecting payments, deductibles, copays, and co-insurance at the center.
Maintain knowledge of payer contracts and guidelines, including Medicare, Medicaid, other government contracts, and workers’ compensation fee schedules.
Contact patients and communicate the center’s financial policy.