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Insurance Verification Specialist II

2 months ago

Newport Beach, United States Hoag Memorial Hospital Presbyterian Full time
Job Summary

We are seeking a highly skilled Insurance Verification Specialist II to join our team at Hoag Memorial Hospital Presbyterian. As a key member of our patient access team, you will play a critical role in ensuring timely reimbursement of services and providing exceptional patient care.

Key Responsibilities
  • Verify insurance and benefits coverage for services in assigned departments
  • Work directly with patients, insurance companies, and clinical departments to obtain proper authorizations and ensure timely reimbursement
  • Review physician orders for medical necessity and accuracy, and 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 in 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
What We Offer

Hoag Memorial Hospital Presbyterian is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. We are committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. We hire a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.