Georgetown Surgery Center - Patient Benefits Coordinator

Georgetown Surgery Center combines excellence and compassion in healthcare, offering a diverse array of surgical specialties. Our multi-specialty team of dedicated experts delivers outstanding care across gastroenterology, orthopedics, general surgery, spine surgery, pain management, ENT, and specialized procedures for hand, foot, and ankle conditions. We also provide a specialized Total Joint Program for knees, hips, and shoulders. Patient-centered care is our guiding principle, ensuring personalized treatment plans through empathy and collaboration.

Regent Surgical Health, since 2001, has been a leader in developing and managing successful surgery center partnerships between hospitals and physicians. We continually evolve the ASC model to stay ahead of emerging trends, offering proprietary ownership models that ensure long-term clinical and financial success for both physicians and hospitals.

About the role

Under the direction of the Business Office Manager, the Insurance Verification Specialist ensures patients have valid and adequate insurance coverage for surgical services. This role involves verifying patient information, insurance eligibility, benefits, authorizations, and referrals before treatment, as well as communicating financial responsibilities to patients. Strong communication with patients and physicians’ offices, attention to detail, and knowledge of healthcare insurance plans and billing procedures are essential.

Responsibilities

• Verify insurance coverage by confirming patient’s insurance eligibility and benefits with various providers (HMOs, PPOs, Medicare, and Medicaid); document and update patient insurance details in the system and maintain up-to-date records.
• Investigate and resolve discrepancies in insurance information attached to patient accounts.
• Ensure valid authorizations were received from the physician’s office for the scheduled procedure; confirm by contacting insurance companies and physician’s offices in the event of missing authorizations.
• Communicate coverage details and financial estimates to patients prior to services rendered; obtain payments for procedures; address insurance-related inquiries.
• Collect any outstanding balances; inform revenue cycle when an account has an outstanding insurance balance.
• Document all necessary information to the billing department for accurate claims processing.
• Adhere to HIPAA and other relevant regulations.
• Understand and apply ICD-10, CPT, and HCPCS codes when verifying coverage.
• Remain current on all case verification; standard operating procedure is two weeks prior to the date of service.
• Notify the Business Office Manager in the event of insurance or authorization discrepancies or balances due.
• Run daily reports to ensure all cases are verified, authorized, and financial counseling is complete.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent.
• Insurance verification or billing experience in a healthcare environment.
• BLS certification (as required by individual ASC policy).

Preferred Qualifications

• Two years of insurance verification or billing experience in a healthcare environment.

Schedule

Full-time, Monday through Friday. No calls, no weekends, and holidays off.