Insurance Verification Specialist - Per Diem
About The Position
The Insurance Verification Specialist coordinates the acquisition of authorization approvals or denials for services performed at Shriners Children's Northern California. The role maintains knowledge of insurance plans, medical terminology, and coding practices; obtains and communicates pre-authorizations; verifies insurance information, benefits, and eligibility; and tracks authorizations and related requests. The position independently uses the electronic medical record and additional databases. This is a per-diem position scheduled on an as-needed basis, with flexible scheduling based on organizational staffing needs and employee availability.
Requirements
- Knowledge of health care insurance systems, including HMO, PPO, Medi-Cal, CCS, and other third-party payer requirements.
- Medical terminology sufficient to communicate with patients, health care providers, and insurance company representatives about appointments, services, procedures, and authorizations.
- Proficiency with Microsoft Office, including Word, Excel, and Outlook.
- Knowledge of insurance qualifying information and requirements.
- Knowledge of practices and protocols related to appointment scheduling procedures.
Nice To Haves
- One year of experience in insurance verification, authorization, medical billing, and utilization.
- High school diploma or GED.
Responsibilities
- Maintain a thorough understanding of major insurance plans, medical terminology, and coding practices.
- Use ICD-10 and CPT codes to support the authorization process.
- Obtain and communicate pre-authorization as required by insurance companies.
- Obtain complete and accurate insurance information, verify benefits, interpret benefit plans, and investigate relevant details.
- Notify the supervisor of known or potential insurance coverage issues.
- Check insurance eligibility.
- Review admission information, including type and duration of service, authorization, and treatment codes.
- Track and obtain authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
- Request authorization for additional services, including extended stays, visits, authorization extensions, and letters of medical necessity; refer to additional resources when necessary.
- Independently maintain and work from the electronic medical record and additional databases.
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What This Job Offers
Education Level
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