Virtual Insurance Professional

Insurance Verification Specialist

Remote

As a trusted provider of home-delivered medical supplies, we empower our clients to live with dignity, independence, and comfort.

As an Insurance Verification Specialist, you'll play a critical part in ensuring our patients receive the essential products and services they need. In this role, you'll obtain, analyze, and verify referral and insurance information accurately and efficiently. You'll work closely with patients, healthcare providers, and insurance companies to support timely billing, clean claim processing, and seamless product delivery.

If you're passionate about helping others, enjoy solving problems, and thrive in a supportive, mission-driven environment, we'd love to welcome you to the ActivStyle family.

Insurance Verification Specialists are responsible for understanding the entire front-end process to ensure successful service for our patients. You will obtain, analyze, and verify the accuracy of information received from referrals, verify insurance to ensure clean claim processing, and ensure timely billing and delivery of products as ordered by physicians. You will educate patients about their financial responsibility when applicable and guide them through the insurance verification process.

Maintain extensive knowledge of different types of payer coverage and insurance policies

Verify patient insurance coverage to ensure necessary procedures are covered by the individual's insurance accurately

Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles

Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required

Complete accurate patient demographic and insurance entry into EMR databases

Enter data accurately into EMR databases, including payer, authorization requirements, coverage limitations, and expiration dates as needed

Spend extensive amounts of time on the phone or on payer websites with insurance companies

Navigate through multiple online EMR systems to obtain applicable documentation

Communicate with Customer Service and Management on an ongoing basis regarding any noticed trends with insurance companies

Verify insurance carriers are listed in the company's database system; Meet quality assurance requirements and other key performance metrics

Remain flexible with work tasks and hours of operation

Utilize company-provided tools to maintain quality, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (Medicare Provider Enrollment, Chain, and Ownership System), and "How-To" documents

Assume on-call responsibilities during non-business hours in accordance with company policy

Complete assigned compliance training and other educational programs as required

Excellent customer service skills

Excellent ability to communicate both verbally and in writing

Proficient computer skills and knowledge of Microsoft Office

Solid ability to learn new technologies and possess the technical aptitude required to understand data flow through systems and system interaction

General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred

Ability to adapt and remain flexible in a rapidly changing environment; High School Diploma or equivalent

One (1) year of work-related experience in healthcare administrative, financial, or insurance customer services, claims, billing, call center, or management regardless of industry

Exact job experience is considered any of the above tasks in a Medicare-certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance

Work environment may be stressful at times, as overall office activities and work levels fluctuate

Subject to long periods of sitting and exposure to computer screens

Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use

May be exposed to angry or irate customers or patients

Excellent ability to effectively communicate both verbally and in writing with customers, demonstrating empathy, compassion, courtesy, and respect for privacy

Medical, Dental, and Vision Benefits

• Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States
• Employee Assistance Program
• Career Growth Opportunities
• Our Commitment to Diversity and Inclusion

At ActivStyle, we don't just accept difference—we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. Apply today to become an Insurance Verification Specialist at ActivStyle!