Job Description

Insurance Verification Clerk

Bon Secours Surgery Center at Harbour View is seeking a detail-oriented and customer-focused Insurance Verification Clerk to join our Business Office team. We are a busy, multispecialty ambulatory surgery center serving the Northern Suffolk community and are affiliated with United Surgical Partners International (USPI). At USPI, our mission is simple: to care for each patient and their family as if they were our owneach patient, each family, each and every time.

The Insurance Verification Clerk plays a critical role in the revenue cycle and patient experience by ensuring accurate insurance verification, eligibility determination, benefits review, and authorization support prior to scheduled procedures. This position works closely with physician offices, patients, insurance carriers, and internal clinical and administrative teams to ensure accurate financial and demographic information is obtained and documented, helping facilitate a seamless and positive surgical experience.

Under the direction of the Business Office Manager, the Insurance Verification Clerk supports the center's operational, financial, and patient satisfaction goals while maintaining compliance with all facility, regulatory, and payer requirements.

Key Responsibilities

• Verify insurance eligibility, benefits, deductibles, co-insurance, out-of-pocket maximums, and coverage limitations for scheduled surgical procedures.
• Obtain and document accurate patient demographic and insurance information within the facility's practice management system.
• Review scheduled procedures to determine authorization and referral requirements.
• Coordinate with physician offices and insurance companies to secure required authorizations and ensure timely approval before services are rendered.
• Communicate with patients regarding insurance coverage, anticipated financial responsibility, payment expectations, and required documentation.
• Review Explanation of Benefits (EOBs), managed care contracts, and payer guidelines to ensure accurate interpretation of coverage and reimbursement requirements.
• Research and resolve insurance discrepancies, eligibility issues, and authorization challenges.
• Maintain detailed and accurate records of verification activities and payer communications.
• Assist with patient registration duties as needed, including updating demographic information and obtaining required signatures and documents.
• Support collection efforts by identifying patient financial responsibility and communicating payment expectations prior to surgery.
• Collaborate with Business Office, Clinical Leadership, Scheduling, and Physician Office personnel to ensure efficient patient throughput and outstanding customer service.
• Maintain compliance with HIPAA regulations and all facility policies related to patient confidentiality.
• Stay current on payer requirements, insurance regulations, and reimbursement trends affecting ambulatory surgery centers.
• Participate in process improvement initiatives designed to enhance operational efficiency and patient satisfaction.

Qualifications

• High School Diploma or GED required.
• Minimum of 2 years of experience in insurance verification, patient access, medical billing, registration, or related healthcare revenue cycle functions.
• Strong knowledge of commercial insurance plans, Medicare, Medicaid, managed care organizations, and workers' compensation benefits.
• Experience verifying insurance eligibility and benefits through payer portals, clearinghouses, and direct payer contact.
• Excellent verbal and written communication skills.
• Strong organizational skills with exceptional attention to detail and accuracy.
• Ability to effectively prioritize multiple tasks in a fast-paced healthcare environment.
• Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and Teams.
• Ability to maintain confidentiality and professionalism while handling sensitive patient information.
• Ambulatory Surgery Center, hospital, or medical practice experience.
• Medical terminology knowledge preferred.
• Understanding of CPT, ICD-10, and authorization requirements.
• Knowledge of insurance reimbursement methodologies and managed care contracts.
• Demonstrated longevity and stability in previous employment.

Who We Are

At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first-class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner.

USPI is committed to, and proud of our inclusive culture. An inclusive culture, in our view, is respectful of differences and nurtures and supports the contributions of each individual, while also embracing and leveraging diversity. A diverse workforce, combined with an inclusive culture, makes USPI stronger and better able to meet the needs of our diverse patient and physician population.

Pay Range: $17.78/hour - $25.78/hour

(Wages are determined based upon a number of factors including, but not limited to, an individual's qualifications and experience.)

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