Insurance Verification Specialist

Job Description

Job Description

Gadzoom Health is a growing Medical Directorship Group dedicated to providing exceptional care to patients in skilled nursing facilities. We are committed to delivering high quality services and improving patient health outcomes. Our team consists of skilled professionals who are passionate about making a difference in the lives of others.

We are seeking a part time Insurance Verification Specialist with strong customer service and communication skills to verify patient insurance coverage and benefits for services provided in our partnered communities across multiple states.

This is a phone intensive position requiring frequent communication with a variety of insurance payers to confirm eligibility, benefits, coverage limitations, and authorization or referral requirements. The Insurance Verification Specialist will accurately document all verification details and ensure insurance information is complete and up to date to help prevent claim denials and reimbursement delays. This position will report to the Director of Revenue Cycle Management and collaborate with insurance payers, SNF partners, practitioners, and internal teams to support clean claims and timely reimbursement.

This position is a part-time, in office role requiring about 20-25 hours per week , with the potential to transition to a hybrid schedule at the manager’s discretion. Following the initial training period, specific workdays and hours may be discussed with the manager based on department needs and the selected candidate’s availability. 

Key Responsibilities:

• Verify patient insurance eligibility and benefits for services provided in skilled nursing facilities across multiple states
• Conduct frequent outbound and inbound calls with insurance payers to confirm coverage, benefit limitations, effective dates, copayments, and coordination of benefits
• Determine whether prior authorization, referral, or additional documentation is required before services are provided
• Access and navigate multiple payer portals and verification systems to obtain accurate coverage information
• Document verification details, reference numbers, payer representatives, and any other relevant information accurately and thoroughly
• Maintain complete and current patient insurance information
• Communicate coverage issues, missing information, and authorization requirements to the appropriate team members
• Assist with resolving insurance discrepancies that could lead to claim denials or reimbursement delays

This is a general overview of the position and not intended to be a comprehensive list. Duties may be added, removed, or modified based on departmental and organizational needs. 

Preferred Qualifications:

• Previous experience with medical insurance verification, eligibility, or revenue cycle processes
• Knowledge of Medicare and Medicaid requirements
• Experience working with insurance plans across multiple states. Familiarity with plans in Utah, Nevada, Texas, and Washington a plus
• Ability to learn new systems and processes quickly. Advanced MD, Gehrimed, Availity, Noridian, Prism, UHC a plus
• Independent and able to maintain accuracy while meeting deadlines
• Ability to navigate multiple payer portals and computer systems efficiently

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