Insurance Verification Specialist

Responsible for verifying patient insurance coverage and benefits, confirming pre-authorizations, and obtaining necessary authorizations for medical services in order to support the revenue cycle by ensuring that insurance information is accurate, billing is appropriate, and claims processing proceeds smoothly.
Essential Functions
-Obtain and verify patient insurance information, including policy details, coverage limits, and effective dates.
-Contact insurance companies or third-party payers to confirm eligibility, benefits, and co-payment or deductible amounts.
-Coordinate with healthcare providers and insurance companies to obtain pre-authorizations or prior authorizations for medical services, surgeries, or procedures.
-Explain insurance benefits and coverage details to patients, ensuring they understand their financial responsibilities and co-payment requirements.
-Enter accurate insurance information into the hospital's billing system and maintain updated records of insurance verification and authorization status.
-Assist the billing team in resolving insurance-related issues that may arise during the claims processing process.
-Communicate with patients to inform them of their insurance verification status and any potential financial obligations.

Education

• High School Diploma or Equivalent required

• Associate's Degree Healthcare Management or related field of study preferred

Experience

• 2+ years of healthcare billing experience preferred

Knowledge, Skills and Abilities

• Knowledgeable of medical billing codes, insurance claim processing, and payment posting procedures.

• Knowledge of healthcare billing regulations, HIPAA, and compliance requirements.

• Strong attention to detail and data accuracy to ensure precise payment posting and reconciliation.

• Excellent communication and customer service skills to interact with insurance companies, patients, and internal stakeholders.

• Demonstrated problem-solving and critical-thinking skills to resolve payment discrepancies and denials effectively.

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.