Salary Range : $20.8200 - $32.0300 / hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

The Insurance Verification Specialist verifies insurance and benefits 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.
• Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving.
• Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
• Accurately enters insurance benefits and authorization information into patient accounts.
• Seeks assistance as needed to maintain service levels.
• May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested.
• Performs other duties as assigned.

Additionally, the Insurance Verification Specialist II oversees a larger volume or variety of accounts. Serves as a direct liaison between insurance carrier and organization and notifies of Utilization Review documentation.

Communicates financial class changes to ensure proper coordination of care. Tightly monitors day-to-day inventory to ensure insurance authorization is in place before services are rendered.

May validate Medicare LTR days. Maintains productivity expectations with low error rates. Serves as a resource to less experienced team members.

Education and Experience

• High school diploma or equivalent required.
• Two to three years’ experience in patient access or related healthcare 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 in related field preferred.

Last updated : 2024-05-11