Insurance Verification

The Insurance Verification Representative is responsible for verifying patient insurance coverage, benefits, and eligibility prior to scheduled surgical procedures. This role ensures accurate and timely verification of benefits, identification of patient financial responsibility, and communication with patients, physicians’ offices, and payers to support a seamless patient experience and optimize revenue cycle performance. 

This is a fast-paced environment that requires attention to detail, accountability, teamwork, and professional behavior while supporting high-quality patient care. 

RESPONSIBILITIES 

• Verify patient insurance eligibility, benefits, and authorization requirements prior to scheduled procedures  

• Confirm coverage details including deductibles, co-pays, co-insurance, out-of-pocket maximums, and plan limitations  

• Obtain and validate pre-authorizations and referrals as required by payer guidelines  

• Communicate financial responsibility clearly to patients, including estimated out-of-pocket costs  

• Work closely with physician offices, schedulers, and the Business Office to ensure all required information is obtained prior to service  

• Identify and resolve discrepancies in insurance information, eligibility, or authorization requirements  

• Maintain accurate and detailed documentation of all verification activities in the system  

• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies  

• Support front-end revenue cycle processes to minimize denials and delays in reimbursement  

• Collaborate with billing, coding, and accounts receivable teams to ensure clean claim submission  

• Provide excellent customer service to patients and internal stakeholders  

KNOWLEDGE, SKILLS, and ABILITIES 

• Strong understanding of health insurance plans (HMO, PPO, EPO, POS, Worker’s Compensation, Self-Pay, and Third-Party payers)  

• Knowledge of insurance verification, authorization processes, and medical terminology  

• Strong attention to detail with a high level of accuracy  

• Ability to communicate effectively with patients, payers, and internal teams  

• Ability to work independently and prioritize tasks in a fast-paced environment  

• Strong problem-solving and critical thinking skills  

• Ability to maintain confidentiality and handle sensitive patient information  

• Self-motivated with the ability to contribute to a collaborative team environment  

REQUIREMENTS 

• High School diploma or equivalent  

• Preferred: 1–3 years of experience in insurance verification, medical front-end revenue cycle, or healthcare administration  

• Experience with electronic medical records (EMR) and/or billing systems  

• Basic knowledge of medical terminology and insurance processes  

• Strong verbal and written communication skills  

• Customer service and patient-focused mindset  

• Ability to multi-task and meet deadlines