Insurance Verification Specialist

Overview

Frontline collector-level role verifying patient insurance coverage, benefits, and eligibility before service delivery, to minimize claim denials and revenue leakage.

What you'll do

• Verify patient insurance eligibility and benefits using online portals (Availity, Emdeon, payer-specific portals) and phone verification.
• Extract, document, and maintain accurate insurance information (policy numbers, group numbers, effective dates, deductibles, copays, out-of-pocket maximums).
• Identify and flag eligibility gaps, excluded services, and prior authorization requirements.
• Research claim denials related to insurance eligibility and submit appeals with supporting documentation.
• Follow up on claim status with insurance carriers and resolve payment discrepancies.
• Manage patient co-insurance, deductible, and out-of-pocket liability calculations.
• Communicate insurance findings and financial liability to patients in compliance with HIPAA and collections regulations.
• Escalate complex cases (secondary insurance, coordination of benefits, lapsed coverage) to Billing Manager or Team Lead.
• Maintain compliance with HIPAA, state insurance regulations, and client-specific SOPs.
• Meet daily production targets for claim touches, turnaround time, and accuracy metrics.

What you'll need

• High School Diploma or GED.
• 1–2 years of medical billing, insurance verification, or collections experience (or equivalent customer service in healthcare).
• Experience with multiple EHR platforms (Epic, Medidata, ModMed, Cerner).
• Proficiency with online insurance portals (Availity, Emdeon, payer platforms) and phone verification systems.
• Strong attention to detail and accuracy (>95% quality threshold).
• Ability to work independently and meet daily production targets.
• Excellent communication skills (written and verbal) in English.
• Proficiency with EHR/PM systems, spreadsheets, and HIPAA-compliant documentation practices.
• Ability to adapt to changing priorities and work in fast-paced, metric-driven environments.

Details

• Remote or hybrid; US-based or international candidates may be considered based on time zone and team structure.
• Standard business hours (EST/CST preferred for client coordination); shift flexibility required for client support.
• Technology requirements: reliable internet (≥25 Mbps), laptop/desktop, phone for client calls, HIPAA-compliant workspace.
• Full-time, permanent position.