Insurance Verification Specialist

3 weeks ago

Portland, Oregon, United States Northwest 31st Bldg Full time
Job Title: Insurance Verification Specialist

At Northwest 31st Bldg, we are seeking a highly skilled Insurance Verification Specialist to join our team. As an Insurance Verification Specialist, you will play a critical role in ensuring that our patients receive the necessary insurance coverage for their medical treatments.

Responsibilities:
  • Verify insurance coverage and secure authorization for patients.
  • Contact insurance companies and/or medical review departments to obtain necessary information.
  • Verify coverage eligibility and obtain benefit information, deductible, co-pays, co-insurance, out-of-pocket maximums, and accumulators.
  • Initiate and validate authorization, notification, and ensure authorizations, pre-certifications, and referrals are secured.
  • Review detailed clinical information of trauma admissions to determine accident-related liability.
  • Follow the same verification procedure for each payor, as most payors require the authorization/pre-certification process even as second or third insurance coverage on a patient.
  • Calculate hospital cost estimates based on plan benefit accumulators and CPT code(s) for hospital services.
  • Identify any cost discrepancies based on coding and/or Payor contract and work with Analyst and vendors to resolve issues.
  • Re-verify eligibility and ensure authorization of days extended for large dollar in-house accounts.
  • Provide customer service regarding insurance information and educate providers and departments regarding authorization protocols and plan benefits.
  • Communicate daily with Physicians' offices, patients, Surgery Scheduling, Customer Service, Financial Counselors, Clinical Resource Counselor/Utilization Review, Managed Care offices, Managed Care onsite RNs, Insurance Companies, LH System Office of Managed Care Contracts, and various other hospital departments such as Patient Access, Imaging, and Rehab.
  • Fax daily admission and discharge reports to designated insurance companies.
  • Refer non-insured or underinsured patients to the Financial Counselor to determine patient liability, Medicaid eligibility, or financial assistance.
Qualifications:
  • Associate's degree in business or healthcare, or equivalent experience, required.
  • Two years of directly applicable healthcare business office experience (billing/credit/collection) or applicable insurance customer service experience required.
  • Demonstrated knowledge of insurance guidelines, including benefits and authorization protocols.
  • Hospital insurance verification experience preferred.

We offer a competitive salary range of USD $20.42 - USD $29.21 /Hr. and a dynamic work environment that values teamwork and professional growth. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.

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