Healthcare Insurance Eligibility and Benefits Specialist-FT Remote

Healthcare Insurance Eligibility and Benefits Specialist-Full time Remote!

Position Summary
The Healthcare Insurance Eligibility and Benefits Specialist is responsible for verifying patient insurance coverage, determining benefits eligibility, obtaining authorization requirements, and ensuring accurate documentation of insurance information prior to services being rendered. This role serves as a liaison between patients, providers, and insurance carriers to facilitate accurate reimbursement, reduce claim denials, and support a positive patient financial experience.

Key Responsibilities
Insurance Verification & Eligibility

• Verify patient insurance coverage through payer websites, clearinghouses, and direct communication with insurance representatives.
• Confirm eligibility, benefits, coverage limitations, copayments, coinsurance, deductibles, and out-of-pocket responsibilities.
• Identify primary, secondary, and tertiary insurance coverage.
• Review policy effective dates and ensure insurance information is current and accurate.

Benefits Investigation

• Determine coverage for scheduled procedures, treatments, diagnostic services, and specialty care.
• Verify benefit limitations, exclusions, medical necessity requirements, and referral requirements.
• Communicate benefit information to patients, providers, and internal teams.
• Estimate patient financial responsibility

Documentation & Compliance

• Accurately document eligibility and benefits verification findings within practice management or electronic health record (EHR) systems.
• Maintain detailed records of payer contacts, reference numbers, and verification outcomes.
• Ensure compliance with HIPAA, organizational policies, and payer guidelines.
• Support audit and quality assurance activities related to insurance verification processes.

Revenue Cycle Support

• Collaborate with scheduling, registration, billing, and coding teams to prevent claim denials related to eligibility issues.
• Assist with denial prevention initiatives and insurance-related problem resolution.
• Identify trends impacting reimbursement and communicate findings to management.

Qualifications  Required

• High school diploma or equivalent.
• Minimum 1–3 years of healthcare insurance verification, eligibility, benefits investigation, patient access, or revenue cycle experience.
• Knowledge of commercial insurance, Medicare, Medicaid, Managed Care, and government healthcare programs.
• Understanding of insurance terminology, including deductibles, copayments, coinsurance, referrals, and prior authorizations.
• Proficiency with payer portals, clearinghouse tools, EHR systems, and Microsoft Office applications.

Preferred

• Associate's or Bachelor's degree in Healthcare Administration, Business, or related field.
• Certification in healthcare revenue cycle, patient access, or medical office administration.
• Experience in specialty healthcare services, hospital, physician practice, or ambulatory care settings.

Knowledge, Skills, and Abilities

• Strong knowledge of healthcare insurance verification and benefits investigation processes.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving abilities.
• Exceptional attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Customer-service-focused approach with professional telephone etiquette.
• Ability to maintain confidentiality and handle sensitive patient information.

Performance Measures

• Eligibility verification accuracy rate.
• Reduction in insurance-related claim denials.
• Timeliness of benefit and authorization verification.
• Patient satisfaction related to insurance and financial communications.
• Compliance with organizational and payer requirements.

Working Conditions

• Remote work environment.
• Frequent use of computer systems, payer portals, and telephone communication.
• May require interaction with insurance carriers, and revenue cycle personnel throughout the workday.

Reports To: Coding Services Director

· Entry Level (0–2 years): $18–$22 per hour 
· Experienced (3–5 years): $22–$28 per hour 

This position is eligible for medical/dental/vision benefits first of the month following date of hire. 401k benefits plus paid holidays and PTO/personal time.