Insurance Verification Specialist

Insurance Verification Specialist

The Insurance Verification Specialist role plays a key role in our front-end revenue cycle process, ensuring patients have a smooth start to their care experience. In this role, you will verify insurance coverage, confirm eligibility and benefits, and help ensure claims go out clean the first time.

Essential Functions and Responsibilities

• Verify patient insurance coverage, eligibility, co-insurance, and deductibles prior to service.
• Review all required documentation to ensure accuracy.
• Maintain working knowledge of different payer types and coverage policies, including Medicare, Medicaid, and Commercial plans.
• Verify mental health and behavioral health benefits, coverage limitations, visit caps, and applicable network requirements.
• Resolve coverage issues and escalate complex cases to a manager.
• Accurately enter patient demographic and insurance information into EMR system, including payer, authorization requirements, coverage limitations, and expiration dates.
• Spend significant time on the phone and on payer websites confirming benefits.
• Communicate coverage details clearly to patients, providers, and internal teams as needed.
• Communicate with Management on an ongoing basis regarding noticed trends with insurance companies.
• Maintain patient confidentiality and comply with HIPAA guidelines at all times.
• Perform other related duties as assigned.

Competencies, Skills, and Abilities

• Excellent customer service skills.
• Analytical and problem-solving skills with attention to detail.
• Excellent ability to communicate both verbally and in writing.
• Proficient computer skills and knowledge of Microsoft Office.
• Works well independently and as part of a team.

Requirements

Required:

• High School Diploma or equivalent.
• One (1) year of work-related experience in healthcare administrative, financial, or insurance customer service, claims, billing, call center, or a related field.

Preferred Qualifications:

• Experience verifying mental health and behavioral health insurance benefits, including Medicaid, Medicare, and commercial plans.
• Experience working within an Electronic Medical Record (EMR/EHR) system.
• Knowledge of insurance authorization, referral, and medical necessity requirements.