Insurance Verification Representative - Surgery Center of Durbin

SCA Health•Jacksonville, FL

About The Position

The Insurance Verification Representative at Surgery Center of Durbin verifies patient insurance eligibility, benefits, and authorizations, and records accurate information in the patient accounting system. The role includes contacting physician offices and patients to obtain necessary details, determining appropriate primary and secondary payers, and following center policies for out-of-network insurance. The representative documents verification findings and communicates estimated patient financial responsibility and center policies before the date of service. The position also obtains and enters authorizations, checks that authorized procedures and related high-cost supplies or equipment are covered, and informs patients when procedures are not payable. It supports patient financial orientation by calculating expected copayments and coinsurance, understanding payer guidelines and contracts, and collecting or communicating applicable patient payments. The representative also contacts patients before service to review physician ownership, advance directives, and patient rights in accordance with CMS Conditions for Coverage guidelines.

Requirements

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

Nice To Haves

Bachelor’s degree preferred, but not required.

Responsibilities

Verify that sufficient information is available to accurately confirm insurance eligibility, contacting the physician office and/or patient as needed.
Determine whether secondary insurance should be added and ensure the correct payer is selected as primary.
Use the center’s selected claims and eligibility vendor and/or payer websites to obtain eligibility, benefits, precertification, 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 about estimated coinsurance, copayments, and deductibles due on or before the date of service, as applicable.
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 they include accurate information, the procedure, date of service, facility name, and an unexpired authorization.
Enter authorizations in the patient accounting system, including procedure names or CPT codes and effective dates.
Ensure high-cost implants, supplies, or equipment rentals are included on authorizations.
Check insurer-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 wishes to proceed.
Calculate patient copayments and estimated coinsurance according to the applicable payer contract and plan.
Ensure acceptance of in-network benefits for out-of-network payers is pre-approved by the SCA Compliance Department.
Understand payer guidelines and processes for collecting payments, deductibles, copayments, and coinsurance, as well as payer contracts and government program guidelines.
Contact patients and communicate the center’s financial policy.