ASC Business Office Staff Tasklists: Insurance Verification Specialist Tips

These tips, part of an ongoing series that identifies ASC business office staff positions and provides suggested responsibilities for auditing purposes and evaluating employee progress, focus on the ASC insurance verification specialist.

Insurance Verification Specialist

1. Obtain payer’s clinical policies and verify that scheduled procedure’s diagnosis codes (from provider) are covered.

2. Using insurance information obtained by scheduler from provider’s office and insurance verification form (computer software or paper), contact appropriate insurance company and obtain the following:

Insurance.jpg

3. Enter all information received into computer in appropriate areas. Make notes on any special information received in appropriate area of computer program.

4. Give completed insurance verification information to patient financial counselor.

5. Notify business office coordinator/administrator immediately if patient is ineligible for coverage. Secure approval for any deviation of coverage from administrator.

6. Contact provider’s office for any necessary authorizations and enter in computer

The next set of tips in this series will focus on the Patient Financial Counselor. Access other tips in this series on ASC staff tasklists.

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