Insurance Verification Specialist I: Urology

Hoag•Irvine, CA

21d

About The Position

The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned departments. The role works directly with patients, insurance companies, and clinical departments to verify coverage, obtain appropriate authorizations, and support timely reimbursement. The specialist reviews physician orders for medical necessity and accuracy and provides clinical documentation to support authorization. They enter insurance information and codes into the billing system, educate patients about benefits and authorization status, and assist with resolving pending or denied authorizations. The role also determines copayment and deductible amounts, maintains charge entry, reconciles daily charges, and enters benefit and authorization information into patient accounts. Assistance should be sought as needed to maintain service levels. The specialist may arrange peer-to-peer evaluations between physician offices and insurance companies and performs other duties as assigned.

Requirements

High school diploma or equivalent.
Two to three years of experience in patient access or related healthcare experience.
Intermediate knowledge of Windows computers and data entry.

Nice To Haves

Experience with billing, insurance verification, coding, authorization guidelines, ICD-10 and CPT-4 coding, and/or medical terminology.
Degree and/or certificate in a related field.
For Outpatient Treatment Center: two to three years of hospital registration experience with a strong emphasis in Oncology.
For Radiation Oncology: two to three years of hospital registration experience with a strong emphasis in Oncology.

Responsibilities

Verify insurance and benefit coverage for services in assigned departments.
Work with patients, insurance companies, and clinical departments to verify coverage, obtain authorizations, and support timely reimbursement.
Review physician orders for medical necessity and accuracy and provide clinical documentation to support authorization.
Code insurance accurately and promptly in the billing system.
Educate patients about service benefits and the status of pending or denied authorizations, and assist with resolution.
Determine copayment and deductible amounts.
Maintain charge entry and reconcile daily charges.
Enter insurance benefit and authorization information into patient accounts accurately.
Seek assistance as needed to maintain service levels.
Arrange peer-to-peer evaluations between physician offices and insurance companies when requested.
Perform other duties as assigned.