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Job Location: Irvine, CA
# of Openings: 1
System ID: 12438
Join Our Amazing Team! Surgical Care Affiliates has an exciting Insurance Verification Representative opportunity within our Revenue Cycle Group and we'd love to hear from you! If you are interested in becoming part of an organization that is helping to improve healthcare, then SCA is the place for you. Your experience in insurance verification is exactly what we are looking for!
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 200 surgical facilities, including ambulatory surgery centers and surgical hospitals, in partnership with approximately 3,000 physicians. For more information on SCA, visit www.scasurgery.com.
Our team members enjoy the following perks:
- Competitive salary
- Quarterly bonuses
- Exceptional benefits (medical, dental, vision, 401K) that begin the first day of employment
- Positive, friendly environment
Accountabilities / 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.
- Contact the patient and communicate the center financial policy
- Bachelor's degree preferred but not required
- Experience checking authorizations
- Must be experienced with cpt codes
- Detailed and able to work in a high production environment
- Healthcare experience a must
- Local or within driving distance
We value Diversity, Inclusion, and Belonging at Surgical Care Affiliates: SCA is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, national origin, disability and genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.