Insurance Verification Clerk

Oro Valley Surgical Suites is a fast-paced ASC environment specializing in total joints, orthopedics, and spine. We are committed to producing the highest quality work and experience for patients and their families. Come find out why we are the facility of choice for surgeons and patients in the Tucson community!

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