Full Time Insurance Service Professional

Insurance Verification Specialist
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. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Accurately enters insurance benefit and authorization information into patient accounts. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Handles more complex accounts and higher volumes. Tightly monitors day-to-day inventory to ensure insurance authorizations are in place before services are rendered. Interprets medical policies and Local Coverage Determination (LCD's) to determine coverage requirements and to facilitate proper authorizations. Serves as a Subject Matter Expert (SME) and internal resource for the team. Participates in process improvement projects.
High school diploma or equivalent 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 related field preferred.
Outpatient Treatment Center: Two to three years' experience in hospital registration with strong emphasis in Oncology preferred.

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than 1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County's health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.News & World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
Pay Range $25.11-$37.43/hourly
Job Schedule Full Time