Insurance Verification Specialist - Part-Time

The Insurance Verification Specialist is responsible for verifying patients' health insurance coverage and benefits before scheduled appointments or medical procedures. This position ensures that insurance information is accurate, eligibility is confirmed, and patients understand their coverage, deductibles, copayments, coinsurance, and authorization requirements.

The specialist works closely with patients, insurance companies, physicians, and medical office staff to minimize billing errors, prevent claim denials, and ensure a smooth registration and billing process.

Essential Duties and Responsibilities

Verify patients' insurance eligibility and benefits through insurance websites, portals, and telephone calls.

Confirm active insurance coverage, effective dates, and termination dates.

Review policy details, including deductibles, copayments, coinsurance, and out-of-pocket maximums.

Verify in-network and out-of-network benefits.

Determine whether referrals or prior authorizations are required for services.

Obtain and document authorization information when necessary.

Contact insurance companies to clarify coverage limitations and exclusions.

Update patient demographics and insurance information in the electronic medical record (EMR) system.

Identify inactive, terminated, or incorrect insurance policies.

Communicate insurance benefits and potential patient financial responsibilities.

Follow up on pending insurance verifications and authorization requests.

Maintain accurate documentation of all verification activities.

Collaborate with scheduling, registration, billing, and clinical departments.

Protect confidential patient information in accordance with HIPAA regulations.

Meet daily productivity, accuracy, and turnaround-time expectations.

Qualifications and Requirements

High school diploma or GED required.

Previous experience in healthcare administration, medical billing, or insurance verification preferred.

Knowledge of medical insurance terminology and healthcare reimbursement processes.

Familiarity with Medicare, Medicaid, commercial insurance, and managed care plans.

Experience using electronic medical records and insurance verification portals.

Strong verbal and written communication skills.

Excellent attention to detail and organizational skills.

Ability to multitask and work in a fast-paced healthcare environment.

Strong customer service and problem-solving abilities.