Insurance Coverage Specialist

3 weeks ago


Irvine, California, United States Hoag Memorial Hospital Presbyterian Full time

Job Summary:

The Insurance Coverage Specialist is responsible for verifying insurance and benefits coverage for services in assigned departments. This role works directly with patients, insurance companies, and clinical departments to ensure timely reimbursement of services.

Key Responsibilities:

  • Verify insurance and benefits coverage for services
  • Work with patients, insurance companies, and clinical departments to ensure timely reimbursement
  • Review physician orders for medical necessity and accuracy
  • Provide clinical documentation to support proper authorization
  • Accurately and timely code insurance in the billing system
  • Provide patient education on service benefits, status of pending or denied authorizations, and assistance in resolving
  • Determine copayment and deductible amounts, maintain charge entry, and reconcile daily charges
  • Accurately enter insurance benefits and authorization information into patient accounts
  • Seek assistance as needed to maintain service levels
  • May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested
  • Perform other duties as assigned

Requirements:

  • High school diploma or equivalent required
  • Two to three years' experience in patient access or related healthcare experience required
  • One year of experience in Insurance Verification 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

Hoag Memorial Hospital Presbyterian is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind.



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