Insurance Verification Specialist - Per Diem

Insurance Verification Specialist

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, part-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