Medical Insurance Eligibility Specialist

Job Description

Job Description

The Cardiovascular Care Group

Position Summary

The Cardiovascular Care Group is seeking a detail-oriented and customer-focused Insurance Eligibility Specialist to join our growing team. This position is responsible for verifying patient insurance coverage, benefits, referrals, and authorization requirements prior to services being rendered. The Insurance Eligibility Specialist works closely with patients, providers, insurance carriers, and internal departments to ensure accurate benefit verification, minimize claim denials, and support a seamless patient experience.

The ideal candidate will possess strong knowledge of medical insurance plans, excellent communication skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.

Essential Duties and Responsibilities:

Insurance Verification & Eligibility

• Verify patient insurance coverage, eligibility, and benefits for scheduled appointments, diagnostic testing, procedures, and office visits.
• Confirm policy information, deductibles, copayments, coinsurance, out-of-pocket obligations, and coverage limitations.
• Review insurance requirements for specialty cardiovascular services and procedures.
• Update and maintain accurate insurance information within the electronic medical record (EMR) and practice management systems.
• Identify and resolve insurance discrepancies prior to patient appointments.

Authorization & Referral Management

• Determine authorization and referral requirements based on payer guidelines.
• Obtain, track, and document required referrals and prior authorizations.
• Coordinate with referring physicians, insurance carriers, and clinical staff to ensure timely approvals.
• Monitor authorization status and promptly address authorization-related issues.

Patient Financial Communication

• Educate patients regarding insurance coverage and estimated financial responsibility.
• Communicate copayment, deductible, and coinsurance obligations before services are provided.
• Assist patients with questions regarding insurance benefits and coverage.
• Provide exceptional customer service while maintaining patient confidentiality.

Revenue Cycle Support

• Collaborate with scheduling, clinical, billing, and collections teams to ensure accurate and complete patient information.
• Assist in preventing claim denials by ensuring eligibility and authorization requirements are met.
• Review work queues and reports to identify accounts requiring follow-up.
• Support departmental initiatives focused on improving revenue cycle performance and patient satisfaction.

Compliance & Documentation

• Maintain compliance with HIPAA and all applicable healthcare regulations.
• Accurately document verification activities, authorization numbers, and payer communications.
• Follow organizational policies, procedures, and quality standards.
• Participate in audits and process improvement initiatives as needed.

Qualifications:

Education

• High School Diploma or GED required.
• Associate degree in Healthcare Administration, Business, or related field preferred.

Experience

• Minimum of 2 years of experience in medical insurance verification, patient access, registration, or revenue cycle operations required.
• Experience working in a physician practice, specialty practice, hospital, or healthcare setting preferred.
• Cardiovascular or specialty care experience preferred.
• Experience verifying commercial, Medicare, Medicaid, and managed care plans.

Knowledge, Skills & Abilities

• Strong understanding of medical insurance plans and payer requirements.
• Knowledge of insurance eligibility verification, referrals, and prior authorizations.
• Familiarity with healthcare terminology and medical office operations.
• Proficiency with EMR and practice management systems.
• Strong organizational and multitasking skills.
• Excellent attention to detail and accuracy.
• Effective verbal and written communication skills.
• Ability to work independently and collaboratively in a team environment.
• Commitment to delivering outstanding patient service.

Preferred Qualifications

• Knowledge of cardiovascular procedures and diagnostic testing.
• Experience with insurance portals and electronic eligibility tools.
• Bilingual skills are a plus.

Benefits:

• Medical (100% paid by the group for Employee Only coverage with the Cigna Bronze plan). 
• Dental – three plans to choose from Delta Dental and Cigna.
• Vision – two plans to choose from Delta VSP.
• Health Savings Account and Flexible Spending Accounts (Healthcare, Dependent Care, Transit and Parking) through Upswing.
• Life Insurance – $25,000 Paid by the group with the option to enroll in additional Voluntary Life Insurance coverage.
• Short-Term Disability and Long-Term Disability through New York Life with the option to enroll in additional voluntary coverage.
• Ancillary optional benefits – Accident, Critical Illness and Hospital Indemnity through New York Life. 
• Paid Time Off 
• Holiday Pay 
• Paid Jury Duty – 1 day of full pay. 
• Employee Assistance Programs through RWJBH and Cigna.
• 401k Employer Contributions – upon eligibility, group contributes 3% 
• Working Advantage and Life Mart Employee Discounts.
• Holiday Party, Employee Appreciation Days, Ice Cream Socials, various Fundraisers and Contests (receive prizes!) – Lots of employee engagement.