Insurance Eligibility Verification Specialist

POSITION DESCRIPTION

I. TITLE OF POSITION: Insurance Eligibility Verification Specialist

II. NATURE OF POSITION: Employee or Staff work in cooperation with the Billing Manager and CFO to manage Insurance Eligibility Verification, verifying patient insurance coverage prior to scheduled medical services. This role ensures accurate eligibility and benefits information is obtained, documented, and communicated to staff and patients to support efficient billing and reimbursement processes. Will correct claims with insurance issues and ensure they are rebilled in a timely manner to maximize revenue.

III. QUALIFICATIONS:

A. High school diploma or equivalent required

B. Proficiency in data entry, Excel, word processing, ten-key calculator and typing required.

C. Works well in environment with firm deadlines; results oriented.

D. Ability to organize, communicate and perform detailed functions required.

E. Insurance knowledge preferred.

IV. SALARY CLASSIFICATION: Non-Exempt

V. RESPONSIBLE TO: Billing Manager

VI. RESPONSIBILITIES:

A. Verify patient insurance eligibility and benefits for upcoming appointments using payor portals or by contacting insurance carriers.

B. Confirm coverage details including copay, deductible, coinsurance, and coverage limitations.

C. Enter accurate insurance and eligibility information into the EMR.

D. Contact patients to obtain missing insurance information.

E. Training PAS on insurance eligibility.

F. Identify and resolve insurance eligibility discrepancies prior to the patient visit if possible.

G. Prepare ad hoc projects for management, as necessary.

H. Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.

I. Document verification results and maintain detailed records for billing and audit purposes.

J. Some traveling to other sites may be required. (10-25%)

K. Other duties as assigned by the Billing Manager.