Surgical Insurance Verification

Job Description

Job Description

Job Title : Surgical Insurance Verification Specialist

Job Summary :

The Surgical Insurance Verification Specialist is responsible for verifying patient insurance coverage and benefits prior to surgical procedures. This role ensures that surgeries are appropriately authorized, patient financial responsibility is communicated, and claims are accurately submitted. The specialist works closely with surgeons, schedulers, and billing staff to minimize denials, streamline the surgical process, and support the clinic’s revenue cycle.

Key Responsibilities :

Verify patient insurance eligibility, coverage, and benefits for all scheduled surgical procedures.

Obtain pre-authorizations or prior authorizations from insurance carriers when required.

Communicate patient financial responsibility, including co-pays, deductibles, and out-of-pocket costs.

Coordinate with surgical schedulers, surgeons, and billing staff to ensure accurate documentation for claims.

Follow up with insurance carriers on pending authorizations or coverage issues.

Maintain accurate records of verifications, authorizations, and patient communications.

Stay current on insurance payer requirements, policy updates, and regulatory compliance related to surgical procedures.

Qualifications :

High school diploma or equivalent required; Associate’s degree preferred.

Prior experience in medical billing, surgical scheduling, or insurance verification preferred.

Strong knowledge of insurance policies, CPT / HCPCS coding, and prior authorization processes.

Excellent communication, organizational, and problem-solving skills.

Proficiency with practice management software and Microsoft Office Suite.