Insurance Verification & Authorization Specialist

United Surgical Partners International, Inc; Moline (IL); On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Paid time off

401k

Job summary

Quad City Gastroenterology is seeking a full-time Insurance Verification Specialist to join our revenue cycle team. You will verify eligibility, manage authorizations, and ensure accurate claim submission for both new and existing patients.

You will collaborate with the Revenue Cycle Manager, coordinate with payers, and help the Front Office collect payments while upholding privacy, confidentiality, and department policies.

Qualifications

• High school diploma or equivalent.
• 1+ year in healthcare customer service, insurance verification, and billing systems (preferred).
• Familiarity with Word, Excel, and Outlook is required.
• Ability to learn new programs and systems.
• Ability to read and evaluate healthcare receivables information.
• Effective and accurate communication with staff, management, and payers.

Responsibilities

• Utilize the current system to conduct insurance verification and validate authorizations for scheduled patients, ensuring eligibility and benefits are in order for accurate claim submission and payment.
• Use the SSI online eligibility verification system, or contact the payer directly via telephone or website.
• Request pre-authorizations for scheduled procedures, urgent procedures, and imaging.
• Accurately document account actions related to pre-certification.
• Coordinate Peer-to-Peer reviews with providers for denied requests.
• Follow up on pending authorization requests in a timely manner.
• Communicate with the Patient Financial Advocate regarding patients’ financial responsibility, ensuring the Front Office can collect payments like copays.
• Have working knowledge of various payer types: commercial, governmental, Medicare, Medicaid, HMOs, etc., and adapt to different payer requirements.
• Review confirmation reports to identify payer rejection issues and implement procedures to reduce future rejections.
• Act as the connection between internal and external customers to assist in billing resolution and elevate issues that impact claim submission and payment.
• Conduct independent research before seeking management assistance.
• Identify billing or payer edit opportunities.
• Follow department policies and procedures to meet payer and regulatory requirements, including record retention, privacy, and confidentiality.
• Meet or exceed daily production goals as defined by the manager.
• Assist management by training, guiding, and supporting other team members in resolving account issues through billing, collection, and denial processing techniques.
• Provide feedback to the manager on areas of concern impacting billing or collections accurately and promptly.
• Exclude clinical tasks related to patient care, such as assessing medical conditions or providing medical advice or recommendations.

Skills

Communication

Healthcare customer service

Learn new programs

Attention to detail

Education

High school diploma or equivalent

Tools

Word

Excel

Outlook

SSI eligibility system

Job description

Quad City Gastroenterology is seeking a full-time Insurance Verification Specialist to join our revenue cycle team. You will verify eligibility, manage authorizations, and ensure accurate claim submission for both new and existing patients.

You will collaborate with the Revenue Cycle Manager, coordinate with payers, and help the Front Office collect payments while upholding privacy, confidentiality, and department policies.