Verification of Benefits Specialist

Essential Duties and Responsibilities

• Verify patient insurance eligibility and benefits using online payer portals, phone calls to insurance companies, and other available resources.
• Accurately document patient coverage details, including plan type, effective dates, mental health and substance abuse benefits, and any limitations or exclusions, in the practice management (PM) system.
• Verify patient cost-sharing information, such as copayments, deductibles, coinsurance, and out-of-pocket maximums.
• Communicate any eligibility issues, discrepancies, or lack of coverage to the front office staff and relevant team members promptly and clearly.
• Collaborate with the billing department to resolve insurance-related issues and ensure accurate claim submissions.
• Provide excellent customer service to patients by answering inquiries regarding insurance benefits and cost-sharing responsibilities.
• Maintain up-to-date knowledge of insurance requirements and regulations across multiple states.
• Stay informed about changes in payer policies and procedures.
• Maintain accurate records of all verification activities.
• Adhere to HIPAA privacy and security regulations.
• Perform other related duties as assigned.

  Qualifications

  • High school diploma or equivalent required; Associate's degree or some college preferred.
  • Minimum of 2 years of experience in healthcare insurance verification, billing, or a related field.
  • Experience with electronic health records (EHR) and practice management (PM) systems.
  • Strong understanding of insurance terminology, benefits, and claims processing.
  • Proficiency in navigating payer portals and using phone systems to verify benefits.
  • Excellent communication (written and verbal) and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Strong attention to detail and organizational skills.
  • Ability to prioritize and manage multiple tasks in a fast-paced environment.
  • Knowledge of HIPAA regulations.
  • Experience with multi-state insurance verification is a plus.
  • Experience with behavioral health billing is a plus.

  Skills

  • Insurance Verification
  • Benefits Investigation
  • Payer Portal Navigation
  • Phone Communication
  • Data Entry
  • Customer Service
  • Problem-Solving
  • Time Management
  • Organization
  • HIPAA Compliance