Insurance Verification Specialist II: Orange Coast Women's Call Team

Hoag•Costa Mesa, CA

21d•$23 - $36

About The Position

The Insurance Verification Specialist II verifies insurance and benefit coverage for services in assigned departments and 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, supplies clinical documentation for authorization, codes insurance in the billing system, educates patients about service benefits and authorization statuses, determines copayments and deductibles, maintains charge entry, reconciles daily charges, and enters benefit and authorization information into patient accounts. The role may arrange peer-to-peer evaluations and performs other duties as assigned. The Specialist II oversees a larger volume or variety of accounts and serves as a liaison between insurance carriers and the organization, notifying carriers of Utilization Review documentation. The role communicates financial-class changes to support appropriate coordination of care and monitors daily inventory to confirm authorizations are in place before services are rendered. It may validate Medicare LTR days, maintains productivity and low-error expectations, and serves as a resource to less experienced team members.

Requirements

High school diploma or equivalent required.
Two to three years of patient access or related healthcare experience required.
One year of Insurance Verification experience required.
Intermediate knowledge of Windows computers and data entry required.

Nice To Haves

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

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 pending or denied authorization status, 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.
Seek assistance as needed to maintain service levels.
Arrange peer-to-peer evaluations between physician offices and insurance companies when requested.
Serve as a liaison between insurance carriers and the organization and notify carriers of Utilization Review documentation.
Communicate financial-class changes to ensure proper coordination of care.
Monitor daily inventory to ensure authorizations are in place before services are rendered.
Validate Medicare LTR days when applicable.
Maintain productivity expectations and low error rates.
Serve as a resource to less experienced team members.
Perform other duties as assigned.