Insurance Verification & Authorization Specialist

Hoag Health System; Costa Mesa (CA); On-site; USD 48,000 - 64,000; Full time

Job summary

Hoag Memorial Hospital Presbyterian in California seeks an Insurance Verification Specialist to verify coverage and obtain authorizations for services in assigned departments. The role interfaces with patients, insurers, and clinical teams to ensure accurate coding and timely reimbursement.

Responsibilities include educating patients on benefits, determining copayments, entering data into the billing system, and coordinating peer-to-peer reviews as needed.

Qualifications

• High school diploma or equivalent required.
• Two to three years’ experience in patient access or related healthcare experience 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.

Responsibilities

• Verifies insurance and benefit coverage for services in assigned department(s).
• Works with patients, insurance companies, and clinical departments to verify coverage and obtain authorizations.
• Codes insurance in the billing system accurately and timely.
• Educates patients on benefits, status of authorizations, and assists with resolving denials.
• Determines copayment and deductible amounts and reconciles daily charges.
• Enters insurance benefit and authorization information into patient accounts.
• Facilitates peer-to-peer evaluations between physician offices and insurers if requested.

Skills

Data entry

Billing

Insurance verification

Education

High school diploma or equivalent

Degree or certificate in related field

Tools

Windows

Job description

Hoag Memorial Hospital Presbyterian in California seeks an Insurance Verification Specialist to verify coverage and obtain authorizations for services in assigned departments. The role interfaces with patients, insurers, and clinical teams to ensure accurate coding and timely reimbursement.

Responsibilities include educating patients on benefits, determining copayments, entering data into the billing system, and coordinating peer-to-peer reviews as needed.