Insurance Verification Specialist

General Summary

Regional Orthopaedic Associates is seeking a detail-oriented and customer-focused Insurance Verification Specialist to join our team. This role is primarily responsible for verifying patient insurance coverage, benefits, and eligibility prior to scheduled appointments, while also supporting incoming call operations. The ideal candidate will ensure accurate collection and validation of insurance and demographic information, communicate coverage details to patients when appropriate, and coordinate with clinical and administrative teams to support a smooth patient experience. This role plays a critical part in minimizing claim denials and ensuring efficient front-end revenue cycle operations.

Principal Duties And Essential Functions

• Verify patient insurance eligibility, benefits, and coverage details prior to appointments, including copays, deductibles, referrals, and authorization requirements.
• Contact insurance carriers via phone or online portals to confirm active coverage and obtain necessary information.
• Accurately document verification details in the practice management system.
• Identify and communicate any coverage issues, discrepancies, or authorization requirements to appropriate staff and/or patients.
• Collect, enter, and update patient demographic and insurance information with a high degree of accuracy.
• Assist patients in understanding their insurance coverage, financial responsibilities, and referral requirements when applicable.
• Triage incoming calls and route them appropriately to clinical or administrative staff.
• Collaborate with front desk, billing, and clinical teams to resolve insurancerelated issues.
• Maintain compliance with HIPAA and all applicable privacy regulations.
• Provide exceptional customer service in all patient interactions.

Job Requirements

• Strong understanding of insurance verification processes, including eligibility checks, benefits, referrals, and prior authorizations.
• Familiarity with commercial insurance plans, Medicare, Medicaid, and managed care plans preferred.
• Proficiency in Microsoft Office (Word, Outlook, Excel) and practice management systems.
• Experience using insurance portals and verification tools is highly desirable.
• Excellent attention to detail and strong organizational skills.
• Effective communication skills, with the ability to explain insurance information clearly to patients.
• Ability to multitask in a fast-paced environment while maintaining accuracy.
• Working knowledge of medical terminology preferred.
• Reliable, self-motivated, and able to work both independently and as part of a team.
• Must consistently monitor and respond to email communications in a timely manner.

Education

A High School Diploma or GED is required; additional healthcare or administrative training is a plus.

Experience

• Prior experience in insurance verification, medical front office, or healthcare revenue cycle preferred.
• Experience in an orthopaedic or specialty practice is a plus but not required.