Insurance Verification Specialist

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

📋 Description

• Confirm patients’ health insurance eligibility and coverage through payer portals, electronic verification systems, and direct contact with insurance providers.

• Examine member details, policy status, effective dates, applicable coverage, benefits, deductibles, copayments, coinsurance, coverage limitations, and patient financial responsibilities.

• Determine primary and secondary insurance coverage along with coordination-of-benefits requirements.

• Recognize payer-specific requirements such as prior authorization, referrals, and certifications for home health and hospice services.

• Manage authorization requests and liaise with internal departments.

• Track pending verification and authorization issues, and communicate outstanding requirements.

• Record payer responses, authorization details, reference numbers, and follow-up activities.

• Elevate complex coverage inquiries, unresolved discrepancies, and reimbursement issues.

• Accurately enter and maintain insurance information in EHRs, billing systems, and approved platforms.

• Keep organized documentation and adhere to HIPAA privacy and security regulations.

• Communicate with insurance representatives as well as admissions, intake, billing, and revenue cycle teams.

• Provide prompt updates regarding verification outcomes, missing information, and coverage-related delays.

• Adhere to verification procedures, documentation standards, and payer guidelines.

• Support quality reviews, audits, and process enhancement initiatives.

• Stay updated on changes in payer procedures and insurance verification practices.

• Undertake other related responsibilities as assigned.

⛳️ Requirements

• High school diploma or equivalent required.

• Strong attention to detail and dedication to maintaining accurate records.

• Good written and verbal communication abilities.

• Basic computer skills, including familiarity with email, internet applications, and data entry.

• Strong organizational skills with the capacity to manage multiple tasks effectively.

• Capability to follow established procedures and meet reasonable deadlines.

• Professional judgment in handling confidential information.

• Ability to work independently while also collaborating effectively with a team.

• Previous experience in insurance verification, medical billing, patient registration, healthcare administration, or revenue cycle management is preferred.

• Familiarity with health insurance terminology, eligibility verification, and benefits review is preferred.

• Experience with Medicare, Medicaid, Medicare Advantage, commercial insurance, or managed care plans is preferred.

• Knowledge of insurance requirements relevant to home health, hospice, or post-acute care is preferred.

• Experience using electronic health records, billing platforms, or insurance payer portals is preferred.

• Familiarity with HIPAA privacy and security practices is preferred.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Paid time off (PTO).

• Paid company holidays.

• Company-sponsored retirement savings plan, such as a 401(k), if offered and applicable.

• Opportunities for professional development and job-related training.

• Career growth opportunities.

• Collaborative work environment.

• Employee assistance or wellness resources, if included in the company’s benefits program.