Verification of Benefits Specialist

Position Overview

Career Strategies is seeking a detail-oriented Verification of Benefits Specialist to join our healthcare team. This role is responsible for verifying patient insurance coverage, determining eligibility for services, and communicating benefit information to patients and healthcare providers to ensure proper reimbursement and financial clearance prior to service delivery.

Key Responsibilities

• Contact insurance companies to verify patient benefits and eligibility for medical, behavioral health, and/or specialty services
• Accurately document all insurance information including coverage details, co-pays, deductibles, out-of-pocket maximums, and authorization requirements
• Determine patient financial responsibility and communicate this information clearly to patients and clinical teams
• Identify and resolve insurance discrepancies or issues prior to service delivery
• Verify in-network vs. out-of-network status and explain implications to patients
• Obtain necessary pre-authorizations or referrals according to insurance requirements
• Maintain detailed records of all verification activities in electronic health record systems
• Stay current with insurance plan changes, policy updates, and industry regulations
• Assist with insurance-related questions from patients, providers, and staff
• Support the revenue cycle team by helping to prevent claim denials through accurate pre-service verification

Qualifications

• High school diploma required; Associate's degree in healthcare administration, medical billing, or related field preferred
• 2+ years of experience in insurance verification, medical billing, or healthcare administration
• Knowledge of medical terminology, CPT/HCPCS codes, and ICD-10 diagnosis codes
• Experience working with various insurance payers including commercial, Medicare, Medicaid, and managed care organizations
• Proficiency in navigating insurance portals (e.g., Availity, Navinet, Emdeon) and verifying benefits through online platforms
• Strong computer skills including electronic health records systems and Microsoft Office Suite
• Excellent verbal and written communication skills for interacting with insurance representatives and patients
• Detail-oriented with strong organizational abilities and time management skills
• Ability to interpret complex insurance policy information accurately