Insurance Verification Specialist I: Urology
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 authorizations, and support timely reimbursement. The specialist reviews physician orders for medical necessity and accuracy, provides clinical documentation to support authorization, codes insurance in the billing system, and enters benefit and authorization information into patient accounts. The role also explains service benefits and authorization status to patients, helps resolve pending or denied authorizations, determines copayment and deductible amounts, maintains charge entry, reconciles daily charges, and may arrange peer-to-peer evaluations between physician offices and insurance companies. Other duties may be 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 department(s).
- Work with patients, insurance companies, and clinical departments to verify coverage and obtain proper authorizations.
- Support timely reimbursement of services.
- Review physician orders for medical necessity and accuracy, and provide clinical documentation to support authorization.
- Accurately and promptly code insurance in the billing system.
- Educate patients about service benefits and the status of pending or denied authorizations, and obtain assistance with resolution.
- Determine copayment and deductible amounts.
- Maintain charge entry and reconcile daily charges.
- Enter insurance benefit and authorization information accurately into patient accounts.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
