Insurance Verification Specialist

Insurance Verification Specialist

Work Arrangement: Remote

About This Opportunity

Ready to make a real difference in people's lives? ActivStyle is seeking compassionate, detail-oriented individuals to join our team, where purpose meets professionalism. As a trusted provider of home-delivered medical supplies, we empower our clients to live with dignity, independence, and comfort.

As an Insurance Verification Specialist, you'll play a critical part in ensuring our patients receive the essential products and services they need. In this role, you'll obtain, analyze, and verify referral and insurance information accurately and efficiently. You'll work closely with patients, healthcare providers, and insurance companies to support timely billing, clean claim processing, and seamless product delivery.

Your attention to detail and commitment to exceptional service will directly impact our patients' experience and access to care. If you're passionate about helping others, enjoy solving problems, and thrive in a supportive, mission-driven environment, we'd love to welcome you to the ActivStyle family.

Why You'll Love Working at ActivStyle

• Meaningful work that positively impacts patients' lives every day
• Supportive and collaborative team culture
• Opportunities for professional growth and development
• Mission-driven organization focused on care, dignity, and service

Position Summary

Insurance Verification Specialists are responsible for understanding the entire front-end process to ensure successful service for our patients. You will obtain, analyze, and verify the accuracy of information received from referrals, verify insurance to ensure clean claim processing, and ensure timely billing and delivery of products as ordered by physicians. You will educate patients about their financial responsibility when applicable and guide them through the insurance verification process.

Essential Functions and Job Responsibilities

• Develop and maintain working knowledge of current products and services offered by the company
• Review all required documentation to ensure accuracy
• Maintain extensive knowledge of different types of payer coverage and insurance policies
• Verify patient insurance coverage to ensure necessary procedures are covered by the individual's insurance accurately
• Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles
• Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required
• Resolve any issues with coverage and escalate complicated issues to a manager
• Complete accurate patient demographic and insurance entry into EMR databases
• Enter data accurately into EMR databases, including payer, authorization requirements, coverage limitations, and expiration dates as needed
• Spend extensive amounts of time on the phone or on payer websites with insurance companies
• Provide pertinent information regarding patient's coverage to relevant parties
• Navigate through multiple online EMR systems to obtain applicable documentation
• Communicate with Customer Service and Management on an ongoing basis regarding any noticed trends with insurance companies
• Verify insurance carriers are listed in the company's database system; if not, request that new carriers be entered
• Contact patients when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process
• Meet quality assurance requirements and other key performance metrics
• Pay attention to detail and maintain great organizational skills
• Remain flexible with work tasks and hours of operation
• Utilize company-provided tools to maintain quality, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (Medicare Provider Enrollment, Chain, and Ownership System), and "How-To" documents
• Assume on-call responsibilities during non-business hours in accordance with company policy
• Maintain patient confidentiality and function within HIPAA guidelines
• Complete assigned compliance training and other educational programs as required
• Participate in educational programs as required
• Perform other related duties as assigned

Competencies, Skills, and Abilities

• Excellent customer service skills
• Analytical and problem-solving skills with attention to detail
• Strong decision-making abilities
• Excellent ability to communicate both verbally and in writing
• Ability to prioritize and manage multiple tasks
• Proficient computer skills and knowledge of Microsoft Office
• Solid ability to learn new technologies and possess the technical aptitude required to understand data flow through systems and system interaction
• General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred
• Work well independently and as part of a team
• Ability to adapt and remain flexible in a rapidly changing environment; be patient, accountable, proactive, take initiative, and work effectively on a team
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form

Education and Experience Requirements

• High School Diploma or equivalent
• One (1) year of work-related experience in healthcare administrative, financial, or insurance customer services, claims, billing, call center, or management regardless of industry
• Exact job experience is considered any of the above tasks in a Medicare-certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance

Physical Demands and Work Environment

• Work environment may be stressful at times, as overall office activities and work levels fluctuate
• Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
• Subject to long periods of sitting and exposure to computer screens
• Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
• Must be able to lift 5 to 10 pounds periodically as needed
• May be exposed to angry or irate customers or patients
• Excellent ability to effectively communicate both verbally and in writing with customers, demonstrating empathy, compassion, courtesy, and respect for privacy
• Mental alertness to perform the essential functions of the position

Amazing Benefits At A Glance

• Team-driven and values-based culture
• Medical, Dental, and Vision Benefits
• Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States
• Employee Assistance Program
• Career Growth Opportunities
• 401(k) and Generous Employer Match Opportunity
• Starting wage: $18 - $21/hour based on experience

Our Commitment to Diversity and Inclusion

At ActivStyle, we don't just accept difference—we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. We are proud to be an equal opportunity workplace and an affirmative action employer.

E-Verify Notice

This employer participates in E-Verify. Following acceptance of any job offer, at the start of employment, the employer will provide the federal government Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify is unable to verify your eligibility for employment, this employer will provide written instructions to give you an opportunity to contact the appropriate agencies and resolve the discrepancy prior to taking any action against continued employment.

Ready to Join Our Team?

Join us and be part of a team dedicated to making healthcare more accessible, one patient at a time. Apply today to become an Insurance Verification Specialist at ActivStyle!