Insurance Verifier

Surgical Care Affiliates Sacramento , CA 94204

Posted 4 weeks ago

Overview

SCA, a leader in the outpatient surgery industry, strategically partners with health plans, medical groups and health systems across the country to develop and optimize surgical facilities. SCA operates more than 210 surgical facilities, including ambulatory surgery centers and surgical hospitals, in partnership with approximately 7,500 physicians. For more information on SCA, visit www.scasurgery.com.

Facility Description:

Centralized Billing Office

Accountabilities / Responsibilities

The Insurance Verification Representative is responsible for ensuring the facility will be reimbursed for the procedures performed by calculating self-pay, costs, verifying eligibility and benefits, obtaining authorizations and comparing procedures scheduled against insurance contracts and approved ASC procedure listings.

Key Responsibilities:

  • Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician office and/or the patient.

  • Utilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information.

  • Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class.

  • Obtain authorizations from insurance companies/physician offices. Ensure complete and accurate information is entered into the patient accounting system and the procedure scheduled, date of service and facility name are on the authorization. Ensure the authorization has not expired.

  • Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract and plan as applicable.

  • Be familiar with individual payer guidelines and the process of collecting over the counter payments/deductibles/co-pay/co-insurance. Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines and workmen's compensation fee schedule.

  • Contact the patient and communicate the center financial policy

  • SCA's goal for each patient's Insurance Verification Rep is complete and accurate. The insurance verifier will document the findings in the patient account and will contact the patient with either estimated co-insurance, co-pay and or deductible amounts due on or before the date of service as applicable.

  • Document all information and outcomes in the Patient Accounting System.

Qualifications

  • High school diploma or equivalent; Associate's Degree or equivalent from a two-year College or technical school preferred

  • Three five years' experience in a medical office, hospital, outpatient surgery center or related field

  • Computer experience, Excel, Word, Medical Billing Software and Applications

  • Working knowledge of Medical Terminology

Please send resumes to aaron.boline@scasurgery.com
2019-5393


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Insurance Verifier

Surgical Care Affiliates