Pre-Verification Specialist

Pre-Verification Specialist

Monday - Friday - Flexible Schedule 7AM - 6PM

Remote

Job Summary The Pre-Verification Specialist is responsible for reviewing patient accounts and insurance information prior to claim submission to ensure accurate billing and reimbursement. This role works within EPIC to identify and correct insurance and claim errors, resolve claim edits and rejections, and maintain productivity standards while supporting revenue cycle operations.

Key Responsibilities

• Perform pre-verification of patient insurance coverage and benefits.
• Review and validate patient demographic and insurance information for accuracy.
• Work claim queues and identify billing issues before claim submission.
• Analyze and resolve claim edits, denials, and rejections.
• Conduct charge reviews to ensure accurate coding and billing.
• Correct insurance-related errors and update account information as needed.
• Utilize EPIC and other revenue cycle systems to manage work queues and documentation.
• Ensure claims meet payer requirements and compliance standards.
• Monitor accounts to prevent delays in reimbursement.
• Maintain productivity expectations of approximately 400 claims per week.
• Collaborate with billing, coding, and insurance teams to resolve discrepancies.
• Document all account actions and corrections accurately.

Qualifications

• Education: High School Diploma or GED, required.
• Experience:
  • Minimum of three years of experience working in healthcare, required.
  • Minimum of three years of experience working with pre-verification, preferred.
• Additional Skills (required): Excellent communication and organizational skills. Knowledge of PC and ability to type. Possess sufficient knowledge of insurance rules and data entry. Good working knowledge of Revenue Cycle, basic accounting, and medical terminology preferred. Ability to work with individuals of all cultures and levels of authority.

Job Opening ID 172639