Insurance Verification Specialist (Full-Time)

Ophthalmology Insurance Verification Specialist

Position Summary:

The Insurance Verification Specialist is responsible for ensuring accurate insurance eligibility, benefits verification, and prior authorization for ophthalmology services. This role plays a key part in preventing claim denials, supporting patient financial counseling, and maintaining smooth revenue cycle operations. The specialist will communicate with patients, insurance carriers, and internal clinical/administrative staff to confirm coverage for office visits, diagnostic testing, procedures, and surgeries.

Key Responsibilities:

• Verify insurance eligibility and benefits for all scheduled ophthalmology appointments, diagnostic tests, and surgical procedures.
• Obtain prior authorizations and pre-certifications for injections, surgeries, and specialty ophthalmic procedures.
• Document verification details and authorization numbers accurately in the practice management/EHR system.
• Review patient financial responsibility (copays, deductibles, coinsurance, out-of-pocket costs) and communicate with front desk or billing team as needed.
• Work with patients to explain coverage, financial obligations, and secure any necessary referrals.
• Contact insurance companies for clarification of benefits, coverage limitations, or authorization requirements.
• Maintain knowledge of payer policies, ophthalmology CPT/HCPCS codes (e.g., cataract surgery, glaucoma procedures, intravitreal injections), and diagnosis-to-procedure coding requirements.
• Collaborate with surgical schedulers and clinical teams to ensure insurance approvals are in place prior to the date of service.
• Monitor expiring authorizations and update as needed.
• Assist billing team with claim denials related to insurance eligibility or authorization issues.
• Maintain HIPAA compliance and protect sensitive patient information at all times.
  
  
  

Qualifications:

• High school diploma or equivalent required; associate degree or medical billing/coding certificate preferred.
• 1–2 years of insurance verification, medical billing, or prior authorization experience (ophthalmology or specialty practice experience strongly preferred).
• Knowledge of medical terminology, CPT/ICD-10 coding, and ophthalmology procedures is highly desirable.
• Proficiency in practice management systems, EHRs, and insurance web portals.
• Strong attention to detail and organizational skills.
• Excellent communication skills for interacting with patients, staff, and insurance representatives.
• Ability to work independently, manage multiple tasks, and meet deadlines.
  
  
  

Core Competencies:

• Accuracy and efficiency in insurance verification
• Understanding of ophthalmology coding and payer requirements
• Problem-solving and follow-through with insurance carriers
• Patient-centered communication
• Team collaboration with billing, scheduling, and clinical staff