Insurance Verification Specialist

About the role

The Insurance Verification Specialist role plays a key role in our front-end revenue cycle process, ensuring patients have a smooth start to their care experience. In this role, you will verify insurance coverage, confirm eligibility and benefits, and help ensure claims go out clean the first time.

Responsibilities

• Verify patient insurance coverage, eligibility, co-insurance, and deductibles prior to service.
• Review all required documentation to ensure accuracy.
• Maintain working knowledge of different payer types and coverage policies, including Medicare, Medicaid, and Commercial plans.
• Verify mental health and behavioral health benefits, coverage limitations, visit caps, and applicable network requirements.
• Resolve coverage issues and escalate complex cases to a manager.
• Accurately enter patient demographic and insurance information into EMR system, including payer, authorization requirements, coverage limitations, and expiration dates.
• Spend significant time on the phone and on payer websites confirming benefits.
• Communicate coverage details clearly to patients, providers, and internal teams as needed.
• Communicate with Management on an ongoing basis regarding noticed trends with insurance companies.
• Maintain patient confidentiality and comply with HIPAA guidelines at all times.
• Perform other related duties as assigned.

Skills

• Excellent customer service skills.
• Analytical and problem-solving skills with attention to detail.
• Excellent ability to communicate both verbally and in writing.
• Proficient computer skills and knowledge of Microsoft Office.
• Works well independently and as part of a team.

Requirements

• High School Diploma or equivalent.
• One (1) year of work-related experience in healthcare administrative, financial, or insurance customer service, claims, billing, call center, or a related field.

Qualifications

• Experience verifying mental health and behavioral health insurance benefits, including Medicaid, Medicare, and commercial plans.
• Experience working within an Electronic Medical Record (EMR/EHR) system.
• Knowledge of insurance authorization, referral, and medical necessity requirements.