Insurance Verification Specialist

Shriners Children’s is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical, dental and vision coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a full-time or part-time status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans. Additional benefits available to full-time and part-time employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Shriners Children’s Northern California is proud to be nationally ranked as a leader in pediatric orthopedics by U.S. News & World Report, in partnership with UC Davis Children’s Hospital. As an ACS-verified Level I Children’s Surgery Center, we are committed to providing world-class care in a family-centered environment. Our state-of-the-art facility specializes in orthopedics, rehabilitation, burns, pediatric surgery and cleft lip and palate services, transforming the lives of thousands of children every year from around the world.

Joining our team means being part of a mission-driven organization dedicated to innovation, collaboration and making a lasting impact on the lives of our patients and their families. At Shriners Children’s Northern California, you’ll find a supportive community, opportunities for growth, and the chance to contribute to life-changing work every day.

The insurance verification specialist coordinates acquisition of authorization approval or denials for services performed.

• Maintains a thorough understanding of all major insurance plans and medical terminology and coding practices. Utilizes ICD10 and CPT codes to assist in this process.
• Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential insurance coverage issues.
• Responsible for checking insurance eligibility.
• Review information for admission including type and duration of service, authorization and treatment codes.
• Responsible for tracking and obtaining authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed. Requests for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
• Independently maintains and works from the electronic medical record and additional databases.
• Assists in the development, organization and maintenance of role specific documents, policies, and tools.
• Meets productivity goals as established by Revenue Cycle Manager and reports daily productivity data to manager.
• Maintains tracking system for follow up on authorization requests.
  
  
  

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Minimum

• HS Diplima/GED
  
  
  

Preferred

• 1+ year of insurance verification, authorization, medical billing and utilization