Customer Service Representative-Verification of Benefits Specialist

Job Summary:

The company is seeking a Verification of Benefits Specialist to support patient therapy access and authorization processes within a healthcare environment. This role is responsible for verifying insurance benefits, coordinating pre-authorizations, supporting utilization review activities, and ensuring timely communication with providers, patients, and insurance carriers. The ideal candidate will possess strong medical billing knowledge, insurance verification experience, and the ability to manage multiple cases in a fast-paced environment.

Key Responsibilities:

• Verify patient insurance benefits and complete authorization requests in a timely manner

• Coordinate prospective and retrospective utilization review activities with insurance carriers

• Obtain authorizations for procedures, facilities, physicians, and medical equipment as required

• Review and audit clinical documentation for accuracy and completeness prior to submission

• Follow up on pending authorization requests and manage appeals for denied cases

• Communicate with provider offices and insurance carriers to obtain required clinical information

• Train providers and patients on authorization processes and coverage requirements

• Maintain accurate case documentation while adhering to company policies and privacy standards

• Manage multiple patient cases simultaneously while meeting required deadlines

• Collaborate with internal teams and field representatives to support patient access initiatives

Required Qualifications:

• High school diploma required

• Associate degree in Nursing, Home Health, Healthcare Administration, or related field preferred

• Minimum 2+ years of experience in utilization review, medical approvals, insurance verification, or a related healthcare environment

• Experience working with insurance carriers and verification of benefits portals

• Knowledge of private insurance, Medicare, and Workers’ Compensation guidelines

• Familiarity with CPT codes and ICD-10CM diagnosis coding

• Experience within a physician’s office, healthcare provider office, or medical billing environment

• Proficiency with Microsoft Office applications including Word and Excel

• Strong organizational, verbal, and written communication skills

• Ability to work effectively in a team-oriented environment and meet strict deadlines

Preferred Qualifications:

• Experience with medical device billing or durable medical equipment billing

• Experience using medical billing software and Salesforce

• Familiarity with Adobe applications and healthcare documentation systems

• Ability to train or present concepts to providers, patients, or internal teams

• Understanding of coinsurance, patient benefits, and reimbursement processes

Benefits:

The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.

Pay Range: $18/hr to $20/hr