Insurance Verification Specialist Department:

Business Office Reports To:

Practice Administrators and/or

ASD Management VP of Business Operations Hours:

8:30am to 5:00pm Position Summary The Insurance Verification Specialist is responsible for verifying patient insurance benefits, obtaining required prior authorizations, calculating patient financial responsibility, and ensuring all insurance information is accurate prior to the date of service. This position works closely with physician offices, patients, and insurance carriers to facilitate timely surgical scheduling and reimbursement while providing excellent customer service. Essential Duties and Responsibilities Insurance Verification Verify patient eligibility and insurance benefits prior to scheduled procedures. Confirm active coverage, deductibles, co-insurance, co-payments, out-of-pocket maximums, and benefit limitations. Determine whether the surgery center and physician are in-network with the patient's insurance plan. Document all verification information accurately in the electronic medical record (EMR) and/or practice management system. Identify any coverage issues and communicate findings to appropriate staff. Prior Authorizations Obtain prior authorizations, referrals, and pre-certifications as required by insurance carriers. Track authorization status to ensure approvals are received before the scheduled procedure. Communicate authorization requirements or delays to physician offices, schedulers, and clinical staff. Maintain accurate authorization records and documentation. Patient Financial Counseling Calculate estimated patient financial responsibility based on verified insurance benefits. Contact patients to discuss estimated out-of-pocket costs. Explain deductibles, co-insurance, co-payments, and payment options in a professional and courteous manner. Contact patients prior to their procedure to review and explain their estimated financial responsibility, including deductibles, co-insurance, co-payments, and any non-covered services. Document patient communications regarding financial responsibility. Cash Handling Responsibilities Count and reconcile the petty cash fund at the end of each business day in accordance with surgery center policies and procedures. Communication & Coordination Serve as a liaison between physician offices, insurance companies, and surgery center staff. Respond to insurance inquiries promptly and professionally. Notify appropriate personnel of insurance changes or authorization issues that may impact scheduled procedures. Assist with resolving insurance discrepancies before the date of service. Documentation & Compliance Maintain accurate and complete insurance verification records. Ensure all documentation meets payer and surgery center requirements. Maintain strict compliance with HIPAA and patient confidentiality regulations. Follow all payer guidelines and surgery center policies. Administrative Support Maintain organized electronic records. Assist with special projects as assigned. Participate in process improvement initiatives to enhance reimbursement and reduce denials. Perform other duties as assigned Cover Front Desk as needed Qualifications Education High school diploma or GED required. Associate degree or healthcare-related education preferred. Experience Minimum of 2 years of medical insurance verification or medical office experience preferred. Ambulatory Surgery Center, hospital outpatient, or physician practice experience preferred. Experience with insurance verification, prior authorizations, and benefit interpretation required. Experience using electronic medical records and practice management software preferred. Knowledge, Skills, and Abilities Strong knowledge of commercial insurance, Medicare, Medicaid, and managed care plans. Understanding of prior authorization and pre-certification requirements. Excellent customer service and communication skills. Strong attention to detail and organizational skills. Ability to manage multiple priorities and meet deadlines. Proficiency with Microsoft Office and electronic medical record systems. Ability to work independently and collaboratively with physicians, staff, and insurance representatives. Professional demeanor and excellent telephone etiquette. Physical Requirements Ability to sit for extended periods. Frequent use of computers, telephones, and office equipment Ability to communicate effectively with patients, physicians, insurance representatives, and staff. Work Environment Fast-paced ambulatory surgery center business office. Frequent telephone and computer work. Daily interaction with patients, physician offices, insurance companies, and surgery center staff. Performance Expectations Complete insurance verification within established timeframes before the date of service. Obtain required authorizations before scheduled procedures. Maintain accurate documentation and minimize insurance-related delays. Demonstrate professionalism, confidentiality, and excellent customer service. Follow all HIPAA regulations and surgery center policies.

Pay:

$18.00 - $20.00 per hour

Benefits:

401(k) Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person