Remote Medical Benefit Verification Specialist

Job Summary

The Benefit Verification Representative is responsible for verifying insurance benefits, eligibility, and authorization requirements to ensure accurate billing and reimbursement for procedures and services. This role interacts with physician offices, patients, and internal departments to coordinate insurance approvals, obtain necessary referrals and authorizations, and communicate patient financial responsibilities. The Insurance Verification Representative ensures compliance with payer guidelines and facilitates a smooth scheduling and billing process for patients.

Essential Functions

• Verifies insurance benefits, eligibility, and pre-determination requirements for all scheduled patients to ensure coverage and minimize claim denials.
• Confirms that the correct insurance package has been loaded into the patient's chart and updates records as needed.
• Reviews provider schedules in the electronic medical record system to obtain referrals for HMO patients and authorizations for procedures and radiology testing.
• Works with hospital radiology and scheduling teams to ensure all necessary authorizations are secured for upcoming procedures.
• Reviews the authorization/referral list in the patient financial system (e.g., Athena) and attaches required authorizations and referrals to pending appointments.
• Utilizes financial and scheduling systems to generate authorizations, verify patient coverage, and ensure all necessary approvals are documented.
• Tracks and monitors authorizations and referrals, ensuring compliance with benchmark data and payer requirements.
• Coordinates with physician offices to resolve issues related to pre-determinations and authorization delays.
• Contacts patients in advance of procedures to notify them of estimated financial responsibility and available payment options.
• Assists and provides backup support for other business office positions as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Healthcare Administration, Business, or a related field preferred
• 1-2 years of experience in insurance verification, patient access, medical billing, or healthcare financial services required
• Experience working with electronic medical records (EMR), patient scheduling systems, and insurance payer portals. preferred

Knowledge, Skills and Abilities

• Strong understanding of insurance verification processes, medical benefit plans, and payer authorization requirements.
• Knowledge of healthcare reimbursement practices, including prior authorization and referral processes.
• Proficiency in electronic medical records (EMR), financial systems, and patient scheduling software.
• Excellent communication and customer service skills to interact professionally with patients, physician offices, and payers.
• Strong attention to detail to ensure accuracy in insurance verification and documentation.
• Ability to work independently and prioritize tasks in a fast-paced environment.
• Knowledge of HIPAA regulations and patient confidentiality requirements.