Insurance Verification Specialist

Position Summary

The Insurance Verification Specialist is a frontline collector-level position responsible for verifying patient insurance coverage, benefits, and eligibility prior to service delivery. This role is critical to minimizing claim denials, reducing revenue leakage, and improving patient financial experience. The specialist works independently and as part of cross-functional teams to ensure accurate insurance data is captured, maintained, and escalated appropriately.

Key Responsibilities

• 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

Required Qualifications

• 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

Technical & System Skills

• Insurance portals: Availity, Emdeon, UHC, Aetna, BCBS, Humana, Cigna, Medicaid, Medicare systems

• EHR/PM systems: Kipu, CollaborateMD, Medidata, ModMed, Cerner, Epic, NextGen, CareLogic

• Google Workspace: Docs, Sheets, Drive for documentation and tracking

• Microsoft Office: Excel for reporting, tracking, and reconciliation

• Zoom, Slack, and standard communication platforms

Work Environment & Conditions

• Remote or hybrid (US-based or international candidates may be considered based on time zone and team structure)

• Shift: 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

• Availability: Full-time, permanent position

Our Values

• Lead with Empathy - Great products and teams are built on empathy—whether for our customers, users, or team members. We take the time to walk in others' shoes, listen actively, and truly understand their challenges, needs, and perspectives.