Insurance Verification Specialist - Full Time

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

Job Summary:

The Insurance Verification Specialist plays a critical role in ensuring that patients' insurance coverage is verified accurately and efficiently before services are provided. This position is responsible for verifying active insurance coverage, including service-specific benefits, documenting copays and deductibles, and ensuring the appropriate authorizations are in place for specified services. The Specialist will also stay current on changes in insurance regulations and maintain detailed, accurate records within the electronic health record (EHR) system.

Essential Duties/Responsibilities:

Insurance Entry and Verification

• Enter insurance information into the EHR system.
• Verify active insurance coverage through payer websites.
• Document copay and deductible information for each patient.
• Add insurance card images to patient files when available through payer websites.

Insurance Updates

• Ensure that insurance is still active prior to the patient's appointment or procedure.
• Reach out to patients to resolve inactive insurance status and obtain updated information.
• Verify and update copay and deductible details as necessary.
• Retrieve and attach snippets of insurance cards from payer websites to ensure the most up-to-date records.

Authorization Management

• Verify and document that required authorizations are in place for specific services, including Tricare, VA, special testing (e.g., MRIs, CT scans, ultrasounds), and injections.
• Ensure all necessary pre-authorizations are obtained for high-risk or special procedures.

Compliance and Continuous Learning

• Stay up to date with changes in insurance regulations, payer policies, and healthcare laws.
• Ensure compliance with HIPAA regulations and internal policies to protect patient information.

Other Duties:

• Other duties as assigned.

Qualifications:

• Exceptional attention to detail and a high degree of accuracy.
• Excellent verbal and written communication skills.
• Strong interpersonal skills, with the ability to work effectively in a fast-paced, team-oriented environment.
• Demonstrated ability to solve problems independently and manage difficult situations with patience and professionalism.
• Familiarity with HIPAA regulations and ensuring confidentiality and security of patient data.
• Strong organizational skills.
• Adaptable to frequent changes in insurance policies.
• Ability to handle multiple tasks efficiently.

Required :

• Education: High school diploma or equivalent.
• Experience: Prior experience in healthcare insurance verification or a related field.

Knowledge:

• Strong understanding of medical terminology, various insurance plans, and billing procedures.
• Proficiency in using EHR and billing software.

Preferred:

ADA Physical Demands:

Rarely (Less than .5 hrs/day) Occasionally (0.6 - 2.5 hrs/day) Frequently (2.6 - 5.5 hrs/day) Continuously (5.6 - 8.0 hrs/day)

Physical Demand

Required?

Frequency

Standing

Occasionally

Sitting

Continuously

Walking

Rarely

Kneeling/Crouching

Lifting