Insurance Verifier

Surgery Partners; Los Angeles (CA); On-site; USD 42,000 - 56,000; Full time

Job summary

Surgery Partners is seeking an Insurance Verification Specialist to verify patient insurance benefits and maintain satisfaction for patients, referring physicians, and insurance companies.

The role emphasizes accuracy in data entry, timely referrals and authorizations, and collaboration with staff to resolve issues and ensure proper coverage for procedures.

Qualifications

• High School diploma or equivalent required.
• Experience in healthcare insurance billing/verification helpful.
• Proficient with computer systems and spreadsheets.

Responsibilities

• Verify patient insurance benefits in a timely manner.
• Obtain referrals and authorizations via phone, fax, or online.
• Review daily reports for required authorizations and verifications.
• Update authorizations when needed and re-verify monthly.
• Enter data accurately in a fast-paced environment.
• Update patient accounts with verification details.
• Coordinate with patients regarding insurance benefits.
• Identify deductibles and co-pays; manage self-pay accounts.
• Notify staff if treatment or service is denied.
• Assist manager with account questions as needed.

Skills

Insurance verification

Data entry

Communication

Customer service

Education

High School diploma or equivalent

Tools

Computer systems

Spreadsheet software

Job description

Surgery Partners is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended(“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualifiedpeople or applicant with regard to any terms or conditions of employment on the basis of such individual’s disability. Consistent with this policy of non-discrimination, the Company will provide reasonable accommodations to an individual with a disability, as defined in the ADA or applicable law, who has made the Company aware of his/her disability, unless doing so would cause an undue hardship to the Company. If you are an applicant and need a reasonable accommodation when applying for job opportunities within the Company or request a reasonable accommodation to utilize the Company’s online employment application, please contact [e-mail]

JOB TITLE: Insurance Verification Specialist

GENERAL SUMMARY OF DUTIES:

Responsible for verifing assigned patient insurance
benefits in a timely manner. Maintains optimal patient, referring physician, and insurance company
satisfaction.

ESSENTIAL FUNCTIONS:

• 1. Ensure all records are maintained in absolute integrity and in compliance with applicable regulations and requirements.
• 2. Obtaining required referrals and authorizations via phone, fax, on-line, etc.
• 3. Review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification.
• 4. Obtaining retro-authorizations or updating existing authorizations in a timely manner.
• 5. Data entry in a fast-paced environment with high expectation on accuracy.
• 6. Updates the patient account with details of the insurance verification.
• 7. Coordinating with patients regarding their insurance benefits.
• 8. Identifies deductibles, co-pays, and self-pay accounts.
• 9. Notifying the appropriate staff members if treatment or service is denied.
• 10. Re-verify patients monthly for active, current insurance.
• 11. Assist manager and other staff with account questions when presented.
• 12. Perform other duties as assigned.
• 13. Relies on experience and judgment to plan and accomplish goals.

EDUCATION:

High School, with 1-2 years experience in healthcare insurance billing and
verification, collections and/or authorizations.

KNOWLEDGE:

• 1. Knowledge of clinic policies and procedures.
• 2. Knowledge of managed care contracts and utilization.
• 3. Knowledge of computer systems, programs and spreadsheet applications.
• 4. Knowledge of medical terminology.
• 5. Knowledge of CPT/ICD-9

SKILLS:

• 1. Skill in gathering and reporting claim information.
• 2. Skill in solving utilization problems.
• 3. Skill in written and verbal communication and customer relations.

ABILITIES:

• 1. Ability to work effectively with medical staff and external agencies.
• 2. Ability to identify, analyze and solve problems.

PHYSICAL/MENTAL DEMANDS:

Requires sitting and standing associated with a normal office environment.

ENVIRONMENTAL/WORKING CONDITIONS:

Normal busy office environment with much computer and telephone work.

This description is intended to provide only basic guidelines for meeting job requirements.

Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Equal Employment Opportunity & Work Force Diversity

Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws. This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc.Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.

Surgery Partners conducts pre-employment screenings including but not limited to criminal background checks and drug testing.