Job Description
Job DescriptionAbout UsReady to Be the Healthcare Hero Behind the Scenes?
We are a leading provider of specialized urological care, dedicated to delivering exceptional patient experiences and advancing the field of urology. Our commitment to excellence is reflected in our state-of-the-art facilities, highly skilled medical professionals, and patient-centered approach. We foster a collaborative and supportive work environment, where team members are valued for their contributions and empowered to grow professionally.
OverviewThe Insurance Verification Specialist is responsible for navigating the complexities of insurance verification, prior authorizations, and medical policies. This role requires a meticulous individual with a strong understanding of healthcare insurance, FDA guidelines, and medical terminology. You will serve as a vital link between patients, providers, and insurance companies, ensuring accurate and timely verification of benefits and authorization for services. This position may require travel to other office locations as needed.
Responsibilities
- Research and interpret current insurance medical policies, FDA guidelines, and dosage limitations
- Review patient charts to ensure medical criteria and FDA guidelines are met for insurance payers
- Cross-reference chart notes, test results, and medication history against medical policies and FDA guidelines
- Confirm patient eligibility and diagnosis requirements for injections and specialty procedures
- Communicate effectively with providers regarding patient eligibility, documentation discrepancies, and insurance requirements
- Guide patients through the prior authorization process and discuss financial assistance options
- Prepare and submit accurate prior authorization and referral requests
- Write appeal and reconsideration letters for denied authorizations
- Maintain accurate and detailed documentation in Athena, including medical policies, FDA guidelines, and communication logs
- Verify insurance information two to three weeks prior to patient appointments and update patient records accordingly
- Calculate patient financial responsibilities and provide estimates
- Address patient and staff inquiries regarding insurance and billing
- Manage and respond to patient messages and voicemails
- Stay current with insurance regulations, HIPAA compliance, and urology-related information
- Collaborate with the billing department to resolve claim issues and improve patient collections
- Perform other related duties as assigned
Qualifications and Skills
- High school diploma or GED required
- Minimum two years of experience in a medical office with scheduling and insurance preauthorization experience
- Knowledge of healthcare insurance, online eligibility systems, and claim status review
- Experience verifying medical policies, benefits, and prior authorizations for injections or specialty procedures preferred
- Excellent written and verbal communication skills
- Strong problem-solving and analytical abilities
- Ability to work independently and as part of a team
- Strong attention to detail and ability to manage multiple tasks concurrently
- Typing speed of 40+ WPM
- Positive professional attitude and team-oriented mindset
- Ability to prioritize work and make decisions under pressure
- Knowledge of medical terminology
- Understanding of contracts, payer/plan codes, insurance laws, and insurance companies
Schedule: Monday - Friday (8:00AM - 5:00PM), IN OFFICE
Compensation: $22.00 Hourly
Apply Today!
We offer employees weekly paychecks (direct deposit), and upon eligibility we offer health insurance (Kaiser), accrued paid sick time (Oregon Paid Sick Leave), and a retirement option (OregonSaves).