Insurance Verification Specialist, PT

Shriners Children's; Salt Lake City (UT); On-site; USD 36,000 - 52,000; Full time

Job summary

Shriners Children’s Salt Lake City is seeking a full-time Insurance Verification Specialist to coordinate authorization approvals and denials for services. You will verify benefits, communicate pre-authorizations, and work with patients and providers to resolve coverage issues.

Ideal candidates have knowledge of health care insurance systems, medical terminology, and proficiency with Microsoft Office; HS diploma or GED is preferred. You’ll join a collaborative, mission-driven pediatric care team.

Qualifications

• Knowledge of health care insurance systems, plans, and third-party payer requirements.
• Medical terminology sufficient to discuss appointments, services, and authorizations.
• Proficiency with Word, Excel, Outlook and related Office tools.
• Understanding of insurance eligibility and benefit verification.

Responsibilities

• Maintains understanding of major insurance plans and medical terminology.
• Obtains and communicates pre-authorization per company requirements.
• Obtains complete insurance information and verifies benefits; flags coverage issues.
• Checks insurance eligibility and updates electronic records.
• Responds to inquiries from patients, providers and staff.
• NotifiesFinance of gaps in coverage or high co-pays before services.
• Greet patients, complete paperwork, enter data into EMR, verify eligibility.
• Explain benefits and financial responsibility to parent/guardian.
• Maintains tracking for follow-up on authorization requests.

Skills

Insurance verification

Pre-authorization

Medical terminology

Microsoft Office

Education

High School Diploma/GED

Tools

Microsoft Word

Excel

Outlook

Job description

Company Overview

Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.

Job Description

The Insurance Verification Specialist coordinates acquisition of authorization approval or denials for services performed at Shriners Children’s Salt Lake City, Utah. We are looking for a full time Insurance Verification Specialist to join the team!

Key Responsibilities

• Maintains a thorough understanding of all major insurance plans and medical terminology and coding practices.
• 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.
• Independently maintains and works from the electronic medical record and additional databases.
• Responds promptly and accurately to telephone, written, and electronic inquiries from patients, providers and in-house departments.
• Notifies Patient Financial Counseling of gaps in coverage and/or high co-pays or deductibles prior to services being rendered.
• Assist with greeting incoming patients, completing/distributing paperwork, entering pertinent patient information into the electronic medical record, and verifying insurance eligibility.
• Responsible for explaining benefits, the billing process and financial responsibility to parent/guardian.
• Maintains tracking system for follow up on authorization requests.

Required Qualifications

• Knowledge of health care insurance systems, HMO, PPO, Medi-Cal, CCS, and other third party payer special requirements
• Medical terminology sufficient to communicate with patients, health care providers and insurance company representatives regarding appointment, 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.

Preferred Qualifications

• 1 year insurance of verification, authorization, medical billing and utilization experience
• High School Diploma/GED

Compensation is determined based on years of relevant experience and departmental equity.