Insurance Verification Specialist - Full Time

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.

All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Job Overview

The Insurance Verification Specialist coordinates acquisition of authorization approval or denials for services performed at Shriners Children's Northern California.

This position is non-exempt, full-time and benefits eligible. The pay range for this position is $24.00 - $32.47/hour. Compensation is determined based on relevant experience and department equity.


Responsibilities

Authorizations

• 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.

Communication

• 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.

Productivity

• Assists in the development, organization and maintenance of role specific documents, policies, and tools.
• Meets productivity goals as established by Revenue Cycle Manager and reports daily productivity data to manager.
• Maintains tracking system for follow up on authorization requests.

This is not an all-inclusive list of this job's responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Qualifications

Required:

• 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:

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