Insurance Verification Specialist: Outpatient Treatment Centers

Primary Duties And Responsibilities The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. Review physician orders for medical necessity and accuracy and provide clinical documentation to support proper authorization. Accurately and timely code insurance in the billing system. Provide patient education of service benefits, status of pending or denied authorizations, and resolve assistance issues. Determine copayment and deductible amounts, maintain charge entry, and reconcile daily charges. Accurately enter insurance benefit and authorization information into patient accounts. Seek assistance as needed to maintain service levels. Arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Perform other duties as assigned. Handle more complex accounts and higher volumes. Tightly monitor day‑day inventory to ensure insurance authorizations are in place before services are rendered. Maintain productivity expectations with low error rates. Verify that scheduled services match with the physician orders on file. Interpret medical policies and Local Coverage Determination (LCD’s) to determine coverage requirements and facilitate proper authorizations. Work all STAT requests within 48 hours. Serve as a Subject Matter Expert (SME) and internal resource for the team. Participate in process improvement projects. Qualifications Education and Experience High school diploma or equivalent required. Two to three years’ experience in patient access or related healthcare experience required. Two years’ insurance verification experience required. Intermediate knowledge of Windows computers and data entry required. Experience with billing, insurance verification, coding, authorization guidelines, ICD‑10 and CPT‑4 coding, and/or medical terminology preferred. Degree and/or certificate or formal training in a related field preferred. Additional Department Specific Requirements Are Outpatient Treatment Center: Two to three years’ experience in hospital registration with strong emphasis in Oncology preferred. Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives. #J-18808-Ljbffr Hoag Health System