PT Home Health Insurance Verification Specialist/Investigator

Part Time Home Health Insurance Verification Specialist

We are seeking an experienced Home Health Insurance Verification Specialist to support insurance eligibility, benefits verification, authorization review, and payer validation activities throughout the patient care lifecycle. This individual will play a critical role in ensuring accurate reimbursement, timely admissions, regulatory compliance, and uninterrupted patient care by validating insurance coverage and payer requirements across a variety of government and commercial health plans.

This role requires a strong understanding of healthcare insurance verification processes, payer guidelines, reimbursement requirements, and the ability to collaborate effectively with both operational and clinical teams.

Key Responsibilities

• Perform comprehensive insurance eligibility and benefits verification prior to admission and throughout the patient care lifecycle.
• Verify Medicare, Medicare Advantage, Medicaid, Medicaid Managed Care, commercial insurance, hospice coverage, self-pay accounts, and specialty program eligibility.
• Review payer-specific requirements, authorization requirements, coverage limitations, and reimbursement methodologies.
• Utilize Epic and multiple payer portals to validate coverage, eligibility, and authorization status.
• Determine primary and secondary payer responsibility and ensure accurate billing pathways.
• Research and resolve insurance discrepancies, coverage changes, policy terminations, and authorization issues.
• Document verification findings and payer communications accurately within the EMR.
• Monitor and manage assigned work queues to ensure timely completion of verification activities.
• Partner with clinicians, case managers, and operational teams regarding coverage, eligibility, and reimbursement impacts.
• Identify reimbursement risks and proactively communicate concerns to appropriate stakeholders.
• Support audits, compliance efforts, and payer-related investigations as needed.
• Maintain productivity, quality, and accuracy standards while managing a high-volume workload.

Required Qualifications

• 3+ years of healthcare insurance verification, patient access, revenue cycle, or related healthcare operations experience.
• Epic experience.
• Experience verifying Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Strong understanding of insurance eligibility, benefits verification, authorizations, and reimbursement processes.
• Experience working with payer portals and eligibility verification tools.
• Exceptional attention to detail and commitment to accuracy.
• Strong communication and customer service skills.
• Ability to work independently in a remote environment.
• Strong organizational and problem-solving skills.

Preferred Qualifications

• Home Health insurance verification experience.
• Home Health revenue cycle experience.
• Knowledge of Home Health billing regulations and reimbursement requirements.
• Experience supporting admissions, recertifications, and episode management workflows.
• Experience collaborating with nurses, case managers, clinicians, and care coordination teams.
• LPN, RN, Patient Access, Insurance Verification, or Revenue Cycle background.

Skills & Competencies

• Healthcare insurance verification
• Eligibility and benefits validation
• Authorization management
• Revenue cycle operations
• Medicare and Medicaid knowledge
• Epic EMR
• Payer portal navigation
• Compliance and documentation
• Critical thinking and problem solving
• Stakeholder communication
• Time management and prioritization