Insurance Verification Representative - Pinehurst Surgery Center

SCA Health; Pinehurst (NC); On-site; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking organization that is redefining specialty care. In this role, you will be pivotal in ensuring accurate insurance verification and authorization processes, directly impacting patient care. Your expertise will help streamline operations in a supportive environment that values teamwork and integrity. With a commitment to continuous improvement and inclusion, this position offers a unique opportunity to grow your career while making a meaningful difference in healthcare. If you are passionate about patient-centered care and enjoy working collaboratively, this is the perfect opportunity for you.

Benefits

Medical Coverage

Dental Coverage

Vision Coverage

401k Plan with Company Match

Paid Time Off

Life Insurance

Disability Insurance

Qualifications

• Strong understanding of insurance verification processes and patient eligibility.
• Ability to communicate effectively with patients and insurance companies.

Responsibilities

• Verify patient insurance information and eligibility for services.
• Obtain necessary authorizations from insurance companies.
• Calculate co-pay and communicate financial policies to patients.

Skills

Insurance Verification

Patient Communication

Financial Orientation

Knowledge of Payer Guidelines

Education

High School Diploma

Associate Degree in Health Administration

Job description

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support, and the teammates who push us forward. Behind every successful facility, procedure, or innovation is a team of 15,000+ professionals working together, learning from each other, and living out the mission, vision, and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics, and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems, and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values:

• Clinical quality
• Integrity
• Service excellence
• Teamwork
• Accountability
• Continuous improvement
• Inclusion

Our values aren’t empty words – they inform our attitudes, actions, and culture. At SCA Health, your work directly impacts patients, physicians, and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians, and improve health care in America.

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, a 401k plan with company match, paid time off, life and disability insurance, and more. Click here to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will.

Responsibilities

Insurance Verification:

• Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician office and/or the patient.
• Determine if a secondary insurance should be added to the patient account, ensuring the appropriate payer is selected for Primary insurance.
• Utilize the center's selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits, and/or pre-certs and authorization information.
• Enter the patient insurance information into the patient accounting system, ensuring the selection is the appropriate payer and associated financial class.
• When the patient’s insurance is Out of Network, notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers.
• SCA’s goal for each patient’s insurance verification is complete and accurate. The insurance verifier will document the findings in the patient account and contact the patient with estimated co-insurance, co-pay, and/or deductible amounts due on or before the date of service as applicable.
• The Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines, reviewing Physician Ownership, Advance Directives, and Patient Rights prior to the date of service.

Authorization:

• Obtain authorizations from insurance companies/physician offices. Ensure complete and accurate information is entered into the patient accounting system, including procedure scheduled, date of service, and facility name. Ensure the authorization has not expired.
• Enter authorization into the patient accounting system, including the name/CPT codes and effective date of the authorized procedures.
• Ensure high-cost implants, supplies, or equipment rentals are included on the authorization.
• Check insurance company-approved procedure lists/medical policies. If a procedure is not payable, notify the patient. If the patient wants to proceed, obtain a signature on Medicare ABN or other non-covered notification form.

Financial Orientation:

• Calculate co-pay and estimated co-insurance due from patients per the individual payer contract and plan.
• Acceptance of in-network benefits for out-of-network payers must be pre-approved by SCA Compliance Dept.
• Be familiar with individual payer guidelines and the process of collecting over-the-counter payments, deductibles, co-pay, and co-insurance. Knowledge of payer contracts including Medicare, Medicaid, and other government contracts, as well as workmen’s compensation fee schedules.
• Contact the patient and communicate the center's financial policy.