Insurance Verification Clerk

Oro Valley Surgical Suites is seeking a detail-oriented and highly organized Insurance Verification Clerk to join our administrative team. This role plays a crucial part in ensuring a seamless patient experience by verifying insurance coverage and eligibility prior to scheduled surgical procedures. The ideal candidate will be committed to accuracy, confidentiality, and top-tier service in a fast-paced ambulatory surgical environment.

Key Responsibilities:

• Verify insurance eligibility and benefits for scheduled procedures using electronic systems or by contacting payers directly

• Confirm authorizations, referrals, and pre-certifications are in place as required by payer guidelines

• Communicate effectively with patients regarding insurance coverage, out-of-pocket estimates, and any requirements prior to surgery

• Coordinate with billing, scheduling, and clinical teams to ensure all necessary information is accurate and complete

• Enter and update insurance and demographic information in the patient management system

• Identify and resolve discrepancies related to insurance information and patient accounts

• Maintain up-to-date knowledge of insurance plans, billing guidelines, and regulatory requirements

• Respond to inquiries from patients, payers, and internal staff in a timely and professional manner

• Assist in identifying trends in claim denials related to insurance verification errors

• Support the Business Office team with additional administrative tasks as needed

Qualifications:

• High school diploma or equivalent required; associate degree or certification in medical billing/coding a plus

• Minimum 1–2 years of experience in insurance verification, preferably in a surgical or outpatient setting

• Familiarity with major insurance carriers, Medicare, Medicaid, and managed care plans

• Knowledge of CPT/ICD coding and medical terminology

• Proficiency with EMR systems and eligibility verification platforms (e.g., Availity, Navinet, etc.)

• Excellent attention to detail, communication, and organizational skills

• Ability to work independently and collaboratively in a team-focused environment

• Demonstrated commitment to maintaining patient confidentiality and HIPAA compliance