Insurance Verification Specialist

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Nashville and Middle Tennessee, specializing in the diagnosis and treatment of musculoskeletal disorders and injuries. With over 90 years of service, TOA operates more than 20 locations across the state.

About the role

The Insurance Verification Specialist ensures timely verification of medical insurance benefits. Responsibilities may vary based on individual experience and organizational needs.

Responsibilities

• Utilize the Workflow Daily Appointment Report to verify insurance and determine compatibility with TOA’s managed care plans.
• Adhere to best practices and procedures outlined in the “VOI Training/Procedure Manual” for day-to-day follow-up tasks.
• Contact patients, their families, insurance companies, and facility personnel to gather necessary verification information.
• Resolve coverage, referral, and precertification issues, escalating complex matters to the immediate manager. Requires basic knowledge of referrals and authorizations.
• Ensure accurate entry and updates of insurance information in the system, including correcting VOBs, authorizations, and clinical referrals. Notify collections if claims require rebilling due to insurance corrections.
• Apply experience and judgment to plan and accomplish goals, demonstrating familiarity with facility concepts, practices, and procedures.

Requirements

• High school diploma required.
• 2-4 years of experience in insurance verification preferred.
• Experience reading and interpreting payer eligibility electronic returns, with the ability to differentiate between insurance plans, copays, deductibles, and coinsurance.
• Strong accuracy, attention to detail, organizational skills, and ability to follow directions.

Benefits

• Competitive salaries based on the Middle Tennessee wage market.
• Comprehensive benefits package, including Medical and Dental coverage.
• Paid Time Off (PTO).
• 401(k) plan with company match, safe harbor match, and profit-sharing match.