Insurance Verification Specialist: Patient Accounting

Hoag•Costa Mesa, CA

About The Position

The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. Reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, status of pending or denied authorizations and gets assistance in resolving. Determines copayment and deductible amounts, maintains charge entry and reconciles daily charges. Accurately enters insurance benefit and authorization information into patient accounts. Seeks assistance as needed to maintain service levels. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Performs other duties as assigned.

Requirements

High school diploma or equivalent required
Two to three years’ experience in patient access or related healthcare 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 related field preferred
Outpatient Treatment Center: Two to three years’ experience in hospital registration with strong emphasis in Oncology preferred
Radiation Oncology: Two to three years’ experience in hospital registration with strong emphasis in Oncology preferred

Responsibilities

Verifies insurance and benefit coverage for services
Works directly with patients, insurance companies, and clinical departments to verify insurance coverage and obtain proper authorizations
Ensures timely reimbursement of services
Reviews physician orders for medical necessity and accuracy
Provides clinical documentation to support proper authorization
Accurately and timely codes insurance in the billing system
Provides patient education of service of benefits, status of pending or denied authorizations
Gets assistance in resolving issues
Determines copayment and deductible amounts
Maintains charge entry and reconciles daily charges
Accurately enters insurance benefit and authorization information into patient accounts
Seeks assistance as needed to maintain service levels
May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested
Performs other duties as assigned