Verification Specialist

About the role

This position is responsible for the daily processing of patient and payer eligibility verification for ground ambulance transports, including Medicare, Medicaid, managed care, and third-party commercial insurance. The role verifies coverage for both emergency and non-emergency ambulance transports, confirms medical necessity documentation requirements, and identifies payer-specific prior authorization needs for scheduled/non-emergency transports (e.g., dialysis, discharge, and facility-to-facility runs).

Responsibilities

• Meets and/or exceeds the daily quota of Medicare, Medicaid, and commercial insurance verifications for ground ambulance transports (minimum of 85 verifications per day).
• Verifies patient eligibility and benefits for both emergency (911) and non-emergency (scheduled) ambulance transports prior to or immediately following dispatch.
• Gathers all pertinent demographic, insurance, and guarantor information from the verification source at the initial encounter or dispatch record.
• Accurately documents verification results, authorization numbers, and payer notes in LOGIS to support clean claim submission.
• Takes necessary steps to obtain missing demographic or insurance information, including faxing facilities, contacting dispatch, and telephone communication with patients or family members when necessary.
• Follows HIPAA guidelines regarding the handling and dissemination of patient information throughout the verification process.
• Coordinates with billing, collections, and dispatch staff to resolve eligibility discrepancies and reduce downstream denials.
• Adheres to company policies and procedures.
• Regular attendance is an essential function of the position.
• Other duties as assigned.

Requirements

• High School Diploma required; Associate's Degree preferred.
• Minimum of nine (9) months of experience in a medical office, EMS, or ambulance billing setting; prior ambulance/EMS eligibility verification experience preferred.
• Texas residency required.
• This is a remote position.

Skills

• Ability to read, analyze, and interpret insurance plans and ambulance-specific coverage policies.
• Working knowledge of Medicare, Medicaid, and commercial insurance benefits as they apply to ground ambulance transport.
• Familiarity with ambulance billing terminology, including HCPCS transport codes, loaded mileage, and origin/destination modifiers, is preferred.
• Proficient in online/web-based payer portal verification as well as verbal (phone-based) verification.
• Accurate, high-level data entry skills with a continuous quality focus.
• Excellent phone and customer service skills.
• Detail-oriented with strong organizational and problem-solving skills.
• Experience with LOGIS, Waystar, or similar EMS billing/clearinghouse platforms is a plus.
• Experience in MS Office and general computer skills.

Physical Requirements

• Frequent use of reference manuals and payer resource materials.