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

Primary Duties and Responsibilities

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. He/she 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.

Additionally, the Insurance Verification Specialist II oversees a larger volume or variety of accounts. Serves as a direct liaison between insurance carrier and organization and notifies of Utilization Review documentation. Communicates financial class changes to ensure proper coordination of care. Tightly monitors day-to-day inventory to ensure insurance authorization is in place before services are rendered. May validate Medicare LTR days. Maintains productivity expectations with low error rates.

Serves as a resource to less experienced team members.

Qualifications

• Education and Experience
• High school diploma or equivalent required.
• Two to three years’ experience in patient access or related healthcare experience required.
• One year of experience in Insurance Verification required.
• Intermediate knowledge of Windows computers and data entry required.
• 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.
• Additional department specific requirements are: Outpatient Treatment Center/Radiation Oncology: Two to three years’ experience in hospital registration with strong emphasis in Oncology preferred.
• License Required: N/A
• License Preferred: N/A Certifications Required
• N/A Certifications Preferred
• N/A