Insurance Verification Representative

Company Overview

SCA Health, part of Optum, is dedicated to redefining specialty care by providing accessible, patient-centered solutions across a network of more than 370 ambulatory surgical centers, 400+ specialty physician clinics, labs, and surgical hospitals nationwide. With a workforce of over 15,000 professionals, the organization thrives on shared values and commitment to quality, integrity, service, teamwork, accountability, continuous improvement, and inclusion.

Role Overview

The Insurance Verification Representative plays a crucial role in ensuring accurate patient insurance verification, authorization processing, and financial orientation within the healthcare setting. This position demands collaboration with physicians, patients, and insurance vendors to facilitate smooth care delivery aligned with regulatory standards and SCA Health policies.

Key Responsibilities

• Verify patient insurance details, confirming eligibility through direct communication with physician offices or patients.
• Assess and add secondary insurance information when applicable, ensuring correct primary payer selection.
• Use designated vendor platforms and payer websites to gather eligibility, benefits, and authorization data.
• Input accurate insurance and authorization data into the patient accounting system, confirming payer accuracy and financial classifications.
• Promptly report out-of-network insurance cases to management and adhere to established policies regarding such payers.
• Document insurance verification findings and communicate estimated patient financial obligations (co-insurance, co-pay, deductibles) prior to service dates.
• Contact patients ahead of services to review physician ownership, advance directives, and patient rights as per CMS Conditions for Coverage guidelines.
• Obtain and manage insurance authorizations, ensuring all procedure details and facility information are accurately recorded and authorizations are current.
• Verify coverage of high-cost implants, supplies, or equipment rentals within authorizations.
• Cross-reference procedures with insurance medical policies; notify patients of non-payable procedures and obtain necessary non-coverage acknowledgement.
• Calculate and communicate anticipated patient financial responsibilities based on payer contracts and individual plans.
• Ensure compliance with approvals for accepting in-network benefits from out-of-network payers.
• Stay informed about payer guidelines, including Medicare, Medicaid, government contracts, and workers' compensation fee schedules.
• Effectively communicate the center's financial policies to patients.

Qualifications

• High School Diploma or GED is mandatory.
• Proven experience in customer service and healthcare insurance verification.
• Capability to calculate co-pays, co-insurance, and out-of-pocket expenses accurately.
• Prior exposure to obtaining pre-certifications is advantageous.
• Healthcare industry experience is required.

Compensation and Benefits

The hourly wage ranges between $22.00 and $24.00. SCA Health provides comprehensive benefits including medical, dental, vision coverage, 401k with company match, paid time off, life and disability insurance among others.