Interventional Radiation Oncology of California provides comprehensive Oncology services in several locations in California. We are seeking an experienced Insurance Verification & Authorization Specialist for ourApple Valleyclinic location. This role plays a vital part in supporting our front office, clinical, and billing departments by ensuring accurate insurance verification, authorization processing, and efficient patient scheduling to promote timely care and optimal reimbursement.
The ideal candidate will have at least two years of related experience, preferably in an outpatient healthcare setting, and a strong understanding of insurance processes and front office operations.
Key Responsibilities:
- Verify patient insurance eligibility and benefits for PPO, HMO, Medicare, and other plan types prior to services being rendered through health plan portals or direct contact, ensuring coverage for dates of service.
- Review patient accounts for open balances at the time of insurance verification and communicate findings appropriately to patients and the billing department.
- Ensure accurate diagnosis (ICD-10) and CPT codes are requested and submitted with authorization requests to support medical necessity and help ensure maximum reimbursement.
- Obtain, process, and track prior authorizations from various insurance carriers in a timely manner.
- Prioritize STAT and urgent authorization requests in accordance with health plan guidelines and contract requirements.
- Collaborate with providers and clinical staff to obtain complete and accurate documentation required for authorization approval, insurance verification, registration, and billing compliance.
- Submit, track, and document authorization requests and outcomes using ARIA EHR.
- Notify scheduling staff promptly of any authorization delays, denials, or issues impacting patient appointments.
- Answer inbound calls in a professional and courteous manner, addressing patient inquiries related to insurance, authorizations, appointments, and balances.
- Identify discrepancies or missing information that may impact claims processing and reimbursement and communicate appropriately.
- Provide front office support as needed in a fast-paced clinical environment.
Qualifications & Requirements:
- Insurance verification and authorization experience required
- Working knowledge of ICD-10 diagnosis codes and CPT coding relevant to authorization requests.
- Understanding of revenue cycle processes and how verification accuracy impacts reimbursement.
- Basic knowledge of medical terminology required.
- Excellent customer service and communication skills with the ability to maintain a professional and courteous tone via phone and email.
- Bilingual in Spanish a plus.
- Proficiency in Google Workspace, Microsoft Excel, and Microsoft Word.
- Experience with ARIA EHR preferred.
- Strong organizational skills with the ability to multi-task in a fast-paced environment.
- Motivated, proactive, and able to work independently as well as in a team environment.
Pay: $24.00 - $27.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
