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INSURANCE VERIFICATION SPECIALIST III - CANCER OP TREATMENT CENTER
Newport Beach, CA The Insurance Verification Specialist verifies insurance and benefits coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, the status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts maintain charge entry and reconcile daily charges. Accurately enters insurance benefit and authorization information into patient accounts. Seeks assistance as needed to maintain service levels. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Performs other duties as assigned. Additionally, the Insurance Verification Specialist III handles more complex accounts and higher volumes. Tightly monitors day-day inventory to ensure insurance authorizations are in place before services are rendered. Maintains productivity expectations with low error rates. Verifies that scheduled services match with the Physician orders on file. Interprets medical policies and Local Coverage Determination (LCDs) to determine coverage requirements and to facilitate proper authorizations. Works all STAT requests within 48 hours. Serves as a Subject Matter Expert (SME) and internal resource for the team and participates in process improvement projects. EDUCATION AND EXPERIENCE: *High school diploma or equivalent required. *Two to three years of experience in patient access or related healthcare experience is required. *Two years' insurance verification experience is 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 or formal training in related field preferred. * Two to three years experience in hospital registration with a strong emphasis in Oncology preferred. |
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