Insurance Verification Representative

About the Company

At SCA Health, we believe health care is about people—the patients we serve, the physicians we support, and the teammates who push us forward. Behind every successful facility, procedure, or innovation is a team of 15,000+ professionals working together, learning from each other, and living out the mission, vision, and values that define our organization. As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics, and numerous labs and surgical hospitals.

Our work spans a broad spectrum of services, all designed to support physicians, health systems, and employers in delivering efficient, value-based care to patients without compromising quality or autonomy. What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values: clinical quality, integrity, service excellence, teamwork, accountability, continuous improvement, and inclusion. Our values inform our attitudes, actions, and culture.

At SCA Health, your work directly impacts patients, physicians, and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians, and improve health care in America.

Responsibilities

• Verify that sufficient information is available for accurate verification and eligibility, including 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 center’s selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits, and/or pre-certs and authorization information.
• Enter patient insurance information into the patient accounting system, ensuring the selection is the appropriate payer and associated financial class. Notify the manager immediately if the patient’s insurance is Out of Network.
• Follow Policies and Procedures when accepting Out of Network payers.
• Document findings in the patient account and contact the patient with estimated co-insurance, co-pay, and/or deductible amounts due on or before the date of service.
• Call each patient as part of center compliance with CMS Conditions for Coverage guidelines to review Physician Ownership, Advance Directives, and Patient Rights prior to the date of service.
• Obtain authorizations from insurance companies/physician offices and ensure complete and accurate information is entered into the patient accounting system.
• Verify the procedure scheduled, date of service, and facility name are on the authorization, and ensure the authorization has not expired.
• Enter authorization into the patient accounting system, including the name/CPT codes and effective date of the authorized procedures.
• Ensure high-cost implant/supply or equipment rental is included on the authorization.
• Check insurance company-approved procedure lists/medical policies. If a procedure is not payable, notify the patient. If the patient wants to proceed, obtain a signature on a Medicare ABN or other non-covered notification form.
• Calculate co-pay and estimated co-insurance due from patients per individual payer contracts and plans.
• Acceptance of in-network benefits for out-of-network payers must be pre-approved by the SCA Compliance Department.
• Be familiar with individual payer guidelines and the process of collecting over-the-counter payments, deductibles, co-pays, and co-insurance.
• Knowledge of payer contracts, including Medicare, Medicaid, other government contracts, guidelines, and workers’ compensation fee schedules.
• Contact the patient and communicate the center’s financial policy.

Requirements

• High School Diploma or GED required.
• Strong customer service experience required.
• Previous healthcare insurance verification experience is required.
• Must be familiar with calculating co-insurance, co-pays, and out-of-pocket costs.
• Previous experience obtaining pre-certification is preferred.
• Healthcare experience is a must.

Pay

USD $22.00/Hr. - USD $24.00/Hr.

Benefits

SCA Health offers a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, a 401k plan with company match, paid time off, life and disability insurance, and more. Visit https://careers.sca.health/why-sca to learn more about our benefits.