Insurance Verification and Authorization Specialist

Responsibilities

• Verify insurance benefits for patients prior to the appointment date.
• Obtain prior authorizations for services requiring pre‑authorization prior to the patient's appointment.
• Review patient accounts for insurance accuracy and update any data as needed to ensure insurance and benefit level information are correct in the patient’s account.
• Investigate referral requirements with insurers and patients as needed.
• Support medical receptionists and other internal teams, including RCM, to facilitate accurate insurance/benefit collection and superior patient experience.
• Notate all insurance benefits and eligibility information in applicable Optima business systems.
• Create patient out-of-pocket estimates based on coverage levels and benefit guidelines and notate applicable business systems.
• Absorb insurance details, pharmacy, and patient preferences during pre-registration.
• Assist field operations with insurance referral interactions and questions.
• Address patient questions related to coverage and financial responsibility to streamline the experience and reduce surprises as needed.
• Maintain accurate patient information within confidential patient accounts and electronic records in accordance with HIPAA.
• Work assigned intra- and inter-departmental inquiries within defined SLAs and escalate priority issues appropriately.

Qualifications

• High school diploma or equivalent; coursework in business administration and/or accounting preferred.
• Minimum of five (5) years of healthcare reimbursement, patient access, or related experience preferred.
• Working knowledge of medical and insurance terminology; ability to interpret eligibility/benefit information and explanations of benefits (EOBs).
• Understanding of professional claims and common billing workflows.
• Outstanding communication skills with the ability to build rapport, actively listen, and educate patients and internal partners.
• Demonstrated problem-solving skills, attention to detail, and ability to prioritize and follow through in a fast-paced environment.
• Ability to work independently and as a collaborative team member across a distributed organization.
• Commitment to confidentiality and compliance with HIPAA and organizational policies.