Insurance Verification Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Confirm patient insurance coverage by utilizing automated databases, direct communication with patients, and liaising with insurance companies.

• Validate insurance benefits, policy numbers, pre-certification requirements, eligibility, and effective coverage dates.

• Execute tasks through standardized controls, including batch processing, caseload management, and established workflows.

• Conduct billing activities for Medicare and commercial insurance that are reimbursable.

• Identify billable cases and ensure timely and accurate generation of bills.

• Validate claims, verify patient eligibility, and escalate any questionable or potentially inaccurate coding for further review.

• Examine insurance and billing details for discrepancies, missing information, or reimbursement challenges.

• Adhere to established timelines, objectives, priorities, and workload expectations.

• Evaluate the appropriateness and accuracy of claims data.

• Engage with internal staff and stakeholders to address billing, insurance, eligibility, and claim discrepancies.

• Utilize office software, electronic databases, and healthcare information systems to document, process, track, and manage activities.

• Maintain comprehensive documentation in accordance with VA, VHA, contractual, and organizational standards.

• Safeguard sensitive patient and insurance information while complying with privacy, security, and data-handling regulations.

• Assist clients of the Department of Veterans Affairs, including the Veterans Health Administration.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• A minimum of two years' experience in insurance verification, medical billing, healthcare revenue cycle, patient financial services, claims processing, or a related administrative role in healthcare.

• Proven experience in verifying insurance eligibility, benefits, coverage dates, policy details, and authorization or pre-certification necessities.

• Familiarity with Medicare and/or commercial health insurance claims and reimbursement procedures.

• Proficient in Microsoft Office applications, electronic databases, and other office or healthcare information systems.

• Strong detail orientation and the ability to accurately review claims, insurance information, and billing documentation while adhering to deadlines.

• Must be legally permitted to work in the United States without employer sponsorship, now or at any future time.

• Must be capable of obtaining and maintaining the necessary federal public trust clearance for this position.

• Preferred: Experience with the Department of Veterans Affairs, Veterans Health Administration, or other federal healthcare programs.

• Preferred: Background in VHA or VA healthcare administrative roles, billing, eligibility, or revenue cycle processes.

• Preferred: Understanding of Medicare, commercial insurance, third-party billing, and healthcare reimbursement criteria.

• Preferred: Knowledge of medical and insurance terminology, claims processing, and healthcare revenue cycle workflows.

• Preferred: Experience with electronic health records, patient management systems, insurance verification platforms, or medical billing software.

• Preferred: Familiarity with claim validation, coding review processes, eligibility confirmation, and identifying billable services.

• Preferred: Excellent written and verbal communication skills with the ability to collaborate effectively across clinical, administrative, billing, and insurance teams.

• Preferred: Capability to handle multiple priorities, fulfill production and quality standards, and work efficiently within standardized workflows.

• Preferred: Experience managing sensitive patient information in compliance with relevant privacy and security regulations.

• Resume must be submitted in Word document format and include dates in each section.

🏝️ Benefits

• Health insurance (medical, dental, and vision)

• Paid time off

• Federal holidays

• Matching 401K plan