Job details

Insurance Verification Representative - Inland Surgery Center

Overview:

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.

Accountabilities / Responsibilities:

Insurance Verification:

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.

Authorization:

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.

Financial Orientation:

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

Qualifications: