PT Home Health Insurance Verification Specialist/Investigator

About the role

We are seeking an experienced Home Health Insurance Verification Specialist to support insurance eligibility, benefits verification, authorization review, and payer validation activities throughout the patient care lifecycle. This role plays a critical role in ensuring accurate reimbursement, timely admissions, regulatory compliance, and uninterrupted patient care.

Responsibilities

• Perform comprehensive insurance eligibility and benefits verification prior to admission and throughout the patient care lifecycle.
• Verify Medicare, Medicare Advantage, Medicaid, Medicaid Managed Care, commercial insurance, hospice coverage, self-pay accounts, and specialty program eligibility.
• Review payer-specific requirements, authorization requirements, coverage limitations, and reimbursement methodologies.
• Utilize Epic and multiple payer portals to validate coverage, eligibility, and authorization status.
• Determine primary and secondary payer responsibility and ensure accurate billing pathways.
• Research and resolve insurance discrepancies, coverage changes, policy terminations, and authorization issues.
• Document verification findings and payer communications accurately within the EMR.
• Monitor and manage assigned work queues to ensure timely completion of verification activities.
• Partner with clinicians, case managers, and operational teams regarding coverage, eligibility, and reimbursement impacts.
• Identify reimbursement risks and proactively communicate concerns to appropriate stakeholders.
• Support audits, compliance efforts, and payer-related investigations as needed.
• Maintain productivity, quality, and accuracy standards while managing a high-volume workload.

Requirements

• 3+ years of healthcare insurance verification, patient access, revenue cycle, or related healthcare operations experience.
• Epic experience.
• Experience verifying Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Strong understanding of insurance eligibility, benefits verification, authorizations, and reimbursement processes.
• Experience working with payer portals and eligibility verification tools.
• Exceptional attention to detail and commitment to accuracy.
• Strong communication and customer service skills.
• Ability to work independently in a remote environment.
• Strong organizational and problem-solving skills.

Qualifications

• Home Health insurance verification experience.
• Home Health revenue cycle experience.
• Knowledge of Home Health billing regulations and reimbursement requirements.
• Experience supporting admissions, recertifications, and episode management workflows.
• Experience collaborating with nurses, case managers, clinicians, and care coordination teams.
• LPN, RN, Patient Access, Insurance Verification, or Revenue Cycle background.

Skills & Competencies

• Healthcare insurance verification.
• Eligibility and benefits validation.
• Authorization management.
• Revenue cycle operations.
• Medicare and Medicaid knowledge.
• Epic EMR.
• Payer portal navigation.
• Compliance and documentation.
• Critical thinking and problem solving.
• Stakeholder communication.
• Time management and prioritization.

Benefits

Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We also offer an ESPP (employee stock purchase program), a 401K program, and a HSA (Health Savings Account on the HDHP plan). Additionally, we provide a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program, and other discounts. Professional development includes an on-demand training program, access to certification prep, and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, along with certification discounts and other perks to associations like CompTIA and IIBA. We also have a dedicated customer service team for our Consultants to address questions around benefits and other resources, as well as a certified Career Coach. For more information on our benefits, programs, support teams, and resources, visit our 'Welcome Packet' provided by an Everforth Apex team member. Everforth Apex is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or 804-523-8228. (Do not submit resumes or solicit consultants to this email address).