Insurance Verification Specialist

Position Summary

The Insurance Verification / Authorization Specialist is responsible for verifying and maintaining accurate member eligibility and insurance information to support G.A. Foods’ home-delivered meal billing and revenue cycle operations.

This position ensures that services are provided and billed under the correct payer, member, authorization, and coverage information. The ideal candidate is highly detail-oriented, comfortable working with payer portals and computer systems, and able to manage a high volume of eligibility verification and data maintenance.

This role serves as an important front-end control within the revenue cycle by helping prevent avoidable claim denials and supporting clean, accurate claims from the beginning of the billing process.

Key Responsibilities

Eligibility Verification

• Verify member eligibility and coverage prior to billing services.
• Confirm active coverage, effective dates, termination dates, payer information, and benefit status.
• Review eligibility through payer portals, electronic systems, and other approved resources.
• Identify changes in member coverage and communicate discrepancies promptly.
• Confirm that the appropriate payer is being billed for services provided.
• Document eligibility verification results accurately and consistently.
• Coordinate with Care Center, Billing, and Revenue Cycle Management (RCM) teams when information is incomplete or conflicting.
• Assist with accounts receivable cleanup when eligibility information is needed to resolve outstanding claims.

Payer Portal Management

• Access and navigate payer portals to verify eligibility and coverage.
• Maintain organized documentation of portal verification activity and results.
• Follow payer-specific verification requirements and procedures.
• Monitor payer portal changes and communicate issues that may affect eligibility verification or billing.

Performance Expectations

• Complete eligibility verification accurately and within established turnaround times.
• Maintain a high level of data accuracy.
• Identify eligibility issues before they result in preventable billing errors or claim denials.
• Maintain complete, accurate, and consistent documentation.
• Meet established daily productivity standards.
• Promptly communicate unresolved eligibility or coverage issues.
• Demonstrate strong attention to detail and ownership of assigned accounts and responsibilities.

Required Qualifications

• High school diploma or equivalent required.
• One (1) or more years of experience in healthcare billing, eligibility verification, insurance, claims, authorization, or revenue cycle operations preferred.
• Strong computer and data-entry skills.
• Ability to navigate multiple systems and payer portals.
• Strong attention to detail and accuracy.
• Ability to manage high-volume work while maintaining quality standards.
• Strong organizational, written, and verbal communication skills.
• Basic to intermediate Microsoft Excel skills.

Work Environment

This is a primarily computer-based position involving extensive use of payer portals, billing systems, Microsoft Excel, email, and other electronic resources.

The Insurance Verification / Authorization Specialist must be able to work independently, manage repetitive and detail-oriented tasks, prioritize competing deadlines, and maintain accuracy in a high-volume revenue cycle environment.

Position Impact

The Insurance Verification / Authorization Specialist serves as an important front-end control within G.A. Foods’ revenue cycle. Accurate eligibility and coverage verification helps ensure services are billed to the correct payer, reduces preventable denials, improves clean claim rates, supports timely reimbursement, and protects revenue before claims enter the accounts receivable process.