Insurance Verification Specialist
About The Position
Shriners Children’s is seeking an Insurance Verification Specialist to coordinate the acquisition of authorization approval or denials for services performed at Shriners Children's Northern California. This role requires a thorough understanding of major insurance plans, medical terminology, and coding practices, including the utilization of ICD10 and CPT codes. The specialist will be responsible for obtaining and communicating pre-authorizations, verifying insurance benefits, interpreting benefit plans, and investigating pertinent details. They will also check insurance eligibility, review admission information, track and obtain authorizations from various carriers, and request input from appropriate team members as needed. The role involves independently maintaining and working from the electronic medical record and additional databases.
Requirements
- Knowledge of health care insurance systems, HMO, PPO, Medi-Cal, CCS, and other third party payer special requirements
- Medical terminology sufficient to communicate with patients, health care providers and insurance company representatives regarding appointment, services, procedures and authorizations.
- Microsoft Office including Word, Excel, Outlook, etc.
- Knowledge of insurance qualifying information and requirements.
- Knowledge of practices and protocols related to appointments scheduling procedures.
Nice To Haves
- 1 year insurance of verification, authorization, medical billing and utilization experience
- High School Diploma/GED
Responsibilities
- Maintains a thorough understanding of all major insurance plans and medical terminology and coding practices.
- Utilizes ICD10 and CPT codes to assist in this process.
- Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
- Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
- Notifies supervisor of known or potential insurance coverage issues.
- Responsible for checking insurance eligibility.
- Review information for admission including type and duration of service, authorization and treatment codes.
- Responsible for tracking and obtaining authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
- Requests for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
- Independently maintains and works from the electronic medical record and additional databases.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
