Insurance Claims Specialist II

4 weeks ago


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

The Insurance Verification Specialist II plays a critical role in ensuring timely reimbursement of services by verifying insurance and benefits coverage for patients in assigned departments. This role requires strong communication and organizational skills, as well as the ability to work effectively with patients, insurance companies, and clinical departments.

Key Responsibilities
  • Verify insurance and benefits coverage for patients in assigned departments
  • Obtain proper authorizations and ensure timely reimbursement of services
  • 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 assist with resolving issues
  • Determine copayment and deductible amounts, maintain charge entry, and reconcile daily charges
  • 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
Work Environment

Hoag Memorial Hospital Presbyterian is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. We are committed to providing a work environment free of discrimination and harassment, and we hire a diverse group of people to reach their full potential in the pursuit of organizational objectives.



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