Insurance Verification Specialist

Key Responsibilities

• Verify patient insurance coverage and eligibility prior to scheduled procedures.
• Obtain necessary pre-authorizations and pre-certifications from insurance companies.
• Confirm patient benefits including deductible, co-pay, co-insurance, and out-of-pocket amounts.
• Communicate financial responsibility to patients and collect or arrange for payments as needed.
• Cookordinate with schedulers, clinical staff, and billing department to ensure accurate documentation and timely submission.
• Accurately input insurance data into the electronic medical records (EMR) system.
• Contact patients, insurance companies, and referring offices as needed for clarification or follow-up.
• Identify and resolve any insurance-related discrepancies prior to the date of service.
• Maintain thorough documentation of verification and authorization processes.
• Stay up to date on insurance requirements and changes in coverage policies.

Qualifications

• High school diploma or GED required.
• Minimum of 1–2 years of experience in insurance verification or medical billing, preferably in a surgical or outpatient setting.
• Knowledge of major insurance carriers, including Medicare, Medicaid, and commercial plans.
• Strong understanding of medical terminology, CPT, and ICD-10 codes.
• Excellent communication and customer service skills.
• Ability to multitask and prioritize in a fast-paced environment.
• Proficiency with EMR and scheduling systems (experience with systems such as NextGen, Epic, or similar is a plus).
• Bilingual (English/Spanish) preferred, but not required.