Hoag Health System
Insurance Verification Specialist III
Hoag Health System, Newport Beach, California, us, 92659
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Insurance Verification Specialist III
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Insurance Verification Specialist III
role at
Hoag Health System The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
Job Description
Primary Duties And Responsibilities
The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
Responsibilities
Accurately enters insurance benefit and authorization information into patient accounts. Seeks assistance as needed to maintain service levels. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Performs other duties as assigned. Handles more complex accounts and higher volumes. Tightly monitors day-day inventory to ensure insurance authorizations are in place before services are rendered. Maintains productivity expectations with low error rates. Verifies that scheduled services match with the Physician orders on file. Interprets medical policies and Local Coverage Determination (LCDs) to determine coverage requirements and to facilitate proper authorizations. Works all STAT requests within 48 hours. Serves as a Subject Matter Expert (SME) and internal resource for the team. Participates in process improvement projects.
Qualifications
Education and Experience
High school diploma or equivalent required. Two to three years experience in patient access or related healthcare experience required. Two years insurance verification experience required. Intermediate knowledge of Windows computers and data entry required. Experience with billing, insurance verification, coding, authorization guidelines, ICD 10 and CPT-4 coding, and/or medical terminology preferred. Degree and/or certificate or formal training in related field preferred.
Additional Department Specific Requirements Are
Outpatient Treatment Center/Radiation Oncology: Two to three years experience in hospital registration with strong emphasis in Oncology preferred.
License Required
N/A
License Preferred
N/A
Certifications Required
N/A
Certifications Preferred
N/A
About Us
Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange Countys health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoags awards and accreditations, https://www.hoag.org/about-hoag/awards-accreditations/ .
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
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Insurance Verification Specialist III
role at
Hoag Health System 1 day ago Be among the first 25 applicants Join to apply for the
Insurance Verification Specialist III
role at
Hoag Health System The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
Job Description
Primary Duties And Responsibilities
The Insurance Verification Specialist verifies insurance and benefit coverage for services in assigned department(s). This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations, and ensure timely reimbursement of services. He/she reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization. Accurately and timely codes insurance in the billing system. Provides patient education of service of benefits, status of pending or denied authorizations, and gets assistance in resolving. Determines copayment and deductible amounts, maintains charge entry, and reconciles daily charges.
Responsibilities
Accurately enters insurance benefit and authorization information into patient accounts. Seeks assistance as needed to maintain service levels. May arrange for peer-to-peer evaluations between physician offices and insurance companies as requested. Performs other duties as assigned. Handles more complex accounts and higher volumes. Tightly monitors day-day inventory to ensure insurance authorizations are in place before services are rendered. Maintains productivity expectations with low error rates. Verifies that scheduled services match with the Physician orders on file. Interprets medical policies and Local Coverage Determination (LCDs) to determine coverage requirements and to facilitate proper authorizations. Works all STAT requests within 48 hours. Serves as a Subject Matter Expert (SME) and internal resource for the team. Participates in process improvement projects.
Qualifications
Education and Experience
High school diploma or equivalent required. Two to three years experience in patient access or related healthcare experience required. Two years insurance verification experience required. Intermediate knowledge of Windows computers and data entry required. Experience with billing, insurance verification, coding, authorization guidelines, ICD 10 and CPT-4 coding, and/or medical terminology preferred. Degree and/or certificate or formal training in related field preferred.
Additional Department Specific Requirements Are
Outpatient Treatment Center/Radiation Oncology: Two to three years experience in hospital registration with strong emphasis in Oncology preferred.
License Required
N/A
License Preferred
N/A
Certifications Required
N/A
Certifications Preferred
N/A
About Us
Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange Countys health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoags awards and accreditations, https://www.hoag.org/about-hoag/awards-accreditations/ .
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
Seniority level
Seniority level
Mid-Senior level Employment type
Employment type
Full-time Job function
Job function
Other Industries
Hospitals and Health Care Referrals increase your chances of interviewing at Hoag Health System by 2x Sign in to set job alerts for Insurance Verification Specialist roles.
Care Review Processor: NIGHT SHIFT California
Service Records Administrator, Consumer Litigation (CA - Remote, Contract)
Santa Ana, CA $52,000.00-$60,000.00 6 days ago Patient Care Coordinator - Medical Front Office - Hiring Now
Front Office Assistant : HMG HB HHC 19582 Peds - Full Time - 08HR - HHC Huntington Beach
Newport Beach, CA $65,000.00-$80,000.00 1 week ago Release of Information Specialist/Medical Records 92868 ONSITE IN HOSPITAL SETTING
Release of Information / Medical Records / Customer Service * Onsite in hospital *
Document Specialist - Contract Administrator
Irvine, CA $66,800.00-$142,800.00 2 weeks ago Front Desk Receptionist for Fast Paced Law Office
Secretary III, District Office/Educational Services 57-25-26
Irvine, CA $38,000.00-$46,000.00 3 days ago Medical Office Administration- Medical Records
Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr