Insurance Verification Specialist — Enable Timely Authorizations

Shriners Hospitals for Children; Sacramento (CA); On-site; USD 40,000 - 56,000; Full time

Job summary

Shriners Children’s Northern California is seeking an Insurance Verification Specialist to coordinate authorization approvals or denials for services. You will handle eligibility checks, benefit verification, and timely carrier communications while ensuring accurate patient information is captured in the EMR.

The role requires knowledge of major insurance plans, medical terminology, and familiarity with ICD10/CPT coding.

Qualifications

• Knowledge of health care insurance systems, HMO, PPO, Medi-Cal, CCS, and other third party payer requirements.
• Medical terminology sufficient to communicate with patients, health care providers and insurance company representatives regarding appointments, services, procedures and authorizations.
• Microsoft Office including Word, Excel, Outlook, etc.
• Knowledge of insurance qualifying information and requirements.
• Knowledge of practices and protocols related to appointments scheduling procedures.

Responsibilities

• Maintains a thorough understanding of all major insurance plans and medical terminology and coding practices.
• Utilizes ICD10 and CPT codes to assist in this process.
• Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential insurance coverage issues.
• Responsible for checking insurance eligibility.
• Review information for admission including type and duration of service, authorization and treatment codes.
• Responsible for tracking and obtaining authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed. Requests for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
• Independently maintains and works from the electronic medical record and additional databases.

Skills

Health insurance systems

Medical terminology

Microsoft Office

Insurance qualifying information

Scheduling procedures

Education

High School Diploma/GED

Job description

Shriners Children’s Northern California is seeking an Insurance Verification Specialist to coordinate authorization approvals or denials for services. You will handle eligibility checks, benefit verification, and timely carrier communications while ensuring accurate patient information is captured in the EMR.

The role requires knowledge of major insurance plans, medical terminology, and familiarity with ICD10/CPT coding.