Insurance Verifier

We are looking for an Insurance Verifier to support pre-service financial clearance for surgical patients in California. This contract position with permanent potential focuses on confirming coverage details, identifying authorization needs, and helping patients understand their expected financial responsibility before scheduled procedures. The person in this role will work closely with clinical, scheduling, and revenue cycle teams to reduce avoidable claim issues and keep cases on track for timely treatment.

Responsibilities:
• Conduct pre-procedure insurance reviews to confirm active coverage and validate plan benefits for scheduled surgical services.
• Assess deductibles, copayments, coinsurance amounts, out-of-pocket limits, and any exclusions that may affect patient liability.
• Determine when prior authorization or referral approval is required and record all supporting details for follow-up by the appropriate teams.
• Examine scheduled services and provider documentation to ensure payer rules and coverage criteria are satisfied before the surgery date.
• Prepare clear cost estimates for patients and explain expected financial obligations with professionalism and empathy.
• Enter complete and accurate verification findings into the electronic medical record and related practice management tools.
• Partner with scheduling, admissions, clinical, and billing personnel to resolve benefit discrepancies or missing information ahead of treatment.
• Escalate potential coverage concerns quickly so patients and care teams can address issues before delays or cancellations occur.
• Maintain thorough records of payer communications, verification activity, and authorization status while following applicable compliance standards.

Qualifications:

• Previous experience in insurance verification, patient access, claims support, or a similar healthcare revenue cycle function.
• Working knowledge of commercial health plans, Medicare, Medicaid, and managed care benefit structures.
• Ability to interpret eligibility responses, benefit details, authorization requirements, and medical necessity guidelines.
• Strong computer skills with experience documenting information accurately in healthcare software systems.
• Clear communication skills for discussing financial responsibility with patients and coordinating with internal teams.
• High attention to detail and strong organizational ability when tracking multiple cases and deadlines.
• Background in a surgery center, hospital, physician office, or comparable clinical setting is preferred.

Compensation

$24.00-$27.00 Hourly

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