Hybrid Insurance Verification Specialist at Precision Healthcare Specialists

Description

The Insurance Verification Specialist is responsible for verifying patient insurance coverage, ensuring proper billing, and minimizing claim denials by confirming benefits prior to appointments or procedures. This role plays a vital part in maintaining efficient revenue cycle operations and a smooth patient experience.

Key Responsibilities:

• Verify patient insurance eligibility, benefits, and authorizations prior to services being rendered.

• Confirm coverage details such as co-pays, deductibles, out-of-pocket maximums, and referrals.

• Contact insurance carriers via phone, online portals, or clearinghouses.

• Accurately document insurance information in the practice management system.

• Obtain and track prior authorizations and referrals as needed.

• Communicate coverage issues or changes to patients and clinical teams.

• Collaborate with schedulers and billing team to ensure service approval.

• Stay updated on payer guidelines and policy changes.

• Assist with follow-ups on pending verifications and authorization denials.

• Maintain patient confidentiality and adhere to HIPAA regulations. 

Requirements

• High school diploma or equivalent required; associate degree preferred.

• 1–3 years of experience in medical insurance verification, pre-certification, or billing in a healthcare setting.

• Knowledge of commercial insurance plans, Medicare, Medicaid, HMOs, PPOs, and other payer types.

• Familiarity with EHR/EMR systems and medical terminology.

• Strong attention to detail and organizational skills.

• Excellent communication skills—both verbal and written.

• Ability to work independently in a high-volume environment.
   

• Bilingual a plus.