Verification Specialist - (OKC Hybrid)

Work Location: Oklahoma City, OK (Hybrid) or Hope, AR | Division/Department: PMBS

About the role

The Ambulance Billing Verification Specialist is responsible for reviewing and verifying ambulance transport records to ensure accurate patient information, insurance coverage, medical necessity documentation, and billing requirements are met prior to claim submission. This position plays a critical role in the revenue cycle by identifying missing or inaccurate information, resolving documentation discrepancies, and ensuring ambulance transports are appropriately prepared for coding and billing. The ideal candidate is detail-oriented, organized, and knowledgeable in healthcare insurance verification, ambulance billing requirements, and payer regulations.

Responsibilities

• Review and verify ambulance transport records to ensure accurate patient information, insurance coverage, medical necessity documentation, and billing requirements are met prior to claim submission.
• Identify missing or inaccurate information, resolving documentation discrepancies, and ensuring ambulance transports are appropriately prepared for coding and billing.
• Review ambulance transport records for completeness and accuracy.
• Verify patient demographics, including name, date of birth, address, and other identifying information.
• Identify and verify primary, secondary, and tertiary insurance coverage.
• Confirm insurance eligibility and benefits for the date of service.
• Identify Medicare, Medicaid, Medicare Advantage, commercial insurance, workers' compensation, and other potential payers.
• Determine appropriate coordination of benefits and payer priority.
• Research and resolve insurance discrepancies, inactive coverage, and missing policy information.
• Identify potential third-party liability, motor vehicle accidents, and other special billing circumstances.

Requirements

The ideal candidate is detail-oriented, organized, and knowledgeable in healthcare insurance verification, ambulance billing requirements, and payer regulations.

• High school diploma or GED.
• Experience in healthcare billing, insurance verification, patient registration, medical records, or revenue cycle operations preferred.
• Ability to interpret insurance eligibility information and payer requirements.
• Strong attention to detail and problem-solving skills.
• Proficiency with computers, electronic medical records, and billing software.
• Ability to manage a high-volume workload while maintaining accuracy.
• Strong written and verbal communication skills.
• Ability to work independently and collaboratively in a team environment.

Physical Requirements

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• The employee may occasionally be required to lift and/or move up to 20 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion.
• Must be able to talk, listen and speak clearly on telephone.
• Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle.