Insurance Verification & Authorization Specialist

Sioux Center Health; Sioux Falls (SD); On-site; USD 26,000 - 34,000; Full time

Job summary

Avera Health is seeking a Financial Clearance Specialist to ensure insurance eligibility, benefits verification, and authorizations are completed promptly. This role focuses on accurate data capture, calculating patient responsibility, and assisting patients with payment options and charity applications.

You will collaborate with multiple departments to optimize reimbursement and maintain regulatory compliance.

Qualifications

• 1-3 years related experience in billing, insurance or registration.
• 1-3 years healthcare experience.
• Associate's finance, business or healthcare.

Responsibilities

• Process eligibility and secure full benefit coverage information with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate.
• Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care.
• Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into the health information system.
• Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information.
• Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator to determine estimated patient responsibility and communicates financial expectations to the patient.
• Educates patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered, and identifies methods of payment available.
• Responsible to screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review.
• Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff.

Skills

Billing experience

Healthcare experience

Customer service

Education

Associate's degree in finance/business/healthcare

Job description

Avera Health is seeking a Financial Clearance Specialist to ensure insurance eligibility, benefits verification, and authorizations are completed promptly. This role focuses on accurate data capture, calculating patient responsibility, and assisting patients with payment options and charity applications.

You will collaborate with multiple departments to optimize reimbursement and maintain regulatory compliance.