Insurance Verification Representative - PGC Endoscopy Center for Excellence

Insurance Verification Specialist

At SCA Health, we believe health care is about people the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization. As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy. What sets SCA Health apart isn't just what we do, it's how we do it. Each decision we make is rooted in seven core values : clinical quality, integrity, service excellence, teamwork, accountability, continuous improvement, and inclusion. Our values aren't empty words they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you'll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America. At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Your ideas should inspire change. If you join our team, they will.

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.
• Determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for primary insurance.
• 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.
• When the patient's insurance is out of network, notify the manager immediately. Follow the policies and procedures when accepting out of network payers.
• SCA's goal for each patient's insurance verification 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.
• The insurance verifier will call each patient as part of center compliance with CMS conditions for coverage guidelines in contacting patient's prior to the date of service to review, physician ownership, advance directives and patient rights.
• 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.
• Enter authorization into patient accounting system. Include the name / CPT codes effective date of the authorized procedures.
• Ensure high cost implant / supply or equipment rental is included on authorization.
• Check insurance company approved procedure lists / medical policies. If procedure is not payable, notify patient. If patient wants to proceed, obtain signature on Medicare ABN or other non-covered notification form.
• Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable.
• Acceptance of in-network benefits for out-of-network payers must be pre-approved by SCA compliance dept.
• Be familiar with individual payer guidelines and the process of collecting over the counter payments / deductibles / copay / co-insurance. Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines and workmen's compensation fee schedule.

Qualifications :

Local or within driving distance USD $20.00 / Hr. USD $29.90 / Hr.