Insurance Verification Specialist

The Insurance Verification Specialist is responsible for verifying patient insurance coverage, eligibility, benefits, and authorization requirements prior to services being rendered. This role plays a critical part in reducing denials, improving cash flow, and ensuring accurate patient financial responsibility by confirming coverage details and communicating clearly with patients, insurers, and internal departments.

Essential Duties and Responsibilities:

1. Verify patient insurance eligibility, coverage, and benefits for scheduled and walk-in services.
2. Identify and obtain required prior authorizations and referrals, when applicable.
3. Validate patient demographic and insurance information for accuracy and completeness.
4. Communicate insurance coverage details and estimated patient responsibility to patients and staff in a clear, professional manner.
5. Document all verification activities accurately in the hospital information system.
6. Resolve insurance discrepancies and follow up on incomplete or conflicting information.
7. Work collaboratively with Patient Access, Coding, Billing, and Denials teams to prevent claim rejections and denials.
8. Assist with insurance education for patients and staff as needed.
9. Adhere to HIPAA and organizational policies related to patient confidentiality and data security.
10. Assist with financial counseling or referral to assistance programs, depending on department structure.
11. Perform other duties as assigned.

• Education & Training:
  • High School diploma or equivalent required
• Experience:
  • Minimum of 1-2 years of healthcare insurance verification, patient access, or revenue cycle experience
  • Experience with prior authorizations and medical necessity guidelines
  • Experience working with high-volume verification workloads
  • Familiarity with hospital or physician billing workflows
• Licensure/Certification/Registration:
  • N/A

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable law.