Benefits Verification Specialist

Description

About Us:

Arizona Home Care is a closed-door home infusion and homecare facility that was first established in 1995. Our service includes both acute and non-acute patient populations by bringing the hospital room to the patient's home. We work with all the major hospitals and providers in the valley including but not limited to: HonorHealth, Banner, Dignity, Valleywise, St. Joes, Hospice of the Valley, and Abrazo.

Our Mission

Our mission is to improve patient outcomes by being the best way home.

Position summary

The Benefits Verification Specialist is responsible for verifying patients’ insurance coverage, determining eligibility and out-of-pocket costs, and supporting accurate, timely authorization and quoting for pharmacy and/or home health services. The role works closely with intake, clinical, billing, and sales teams to prevent denials and ensure a smooth start of care for patients.

Key responsibilities

• Verify patient eligibility and benefits for commercial, Medicare, Medicaid, and other payors for all referred services (e.g., infusion, DME, home health, specialty drugs).
• Obtain detailed coverage information, including copays, coinsurance, deductibles, OOP maximums, visit limits, and any prior authorization or pre-certification requirements.
• Calculate and document patient out-of-pocket estimates and quotes according to internal fee schedules and contract terms.
• Initiate, track, and follow up on prior authorizations, pre-certifications, and medical necessity reviews as required by payors.
• Communicate benefit details and financial responsibility clearly to internal teams and, when appropriate, directly to patients or caregivers.
• Document all verification steps, payor conversations, reference numbers, and outcomes in the EMR/PM system in a clear, compliant manner.
• Collaborate with intake, pharmacy, nursing, and billing to resolve coverage issues, benefit exceptions, and alternative payor options (secondary insurance, copay cards, PAPs, etc.).
• Escalate complex benefit or authorization issues to leadership or reimbursement specialists with clear summaries and recommendations.
• Maintain a high level of accuracy and productivity while meeting turnaround time expectations for new referrals and recertifications.
• Stay current on payor policies, formularies, billing requirements, and coverage criteria for key therapies/services.
• Support denial prevention by identifying benefit-related risks upfront and communicating required documentation to clinical and intake teams.
• Protect patient privacy and comply with HIPAA and all applicable regulatory and company policies.

Equal Employment Opportunity (EEO)

It is the policy of Premier Infusion & Healthcare Services to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Premier Infusion & Healthcare Services will provide reasonable accommodations for qualified individuals with disabilities.

Job Type: Full-time

Work Location: In person

Requirements

Qualifications

• High school diploma or equivalent required; associate degree or higher in healthcare administration, business, or related field preferred.
• 1–3 years of experience in insurance verification, benefits coordination, prior authorization, billing, or revenue cycle in a healthcare, pharmacy, or home health setting.
• Working knowledge of commercial insurance, Medicare/Medicaid rules, and common benefit structures (HMO, PPO, EPO, HDHP).
• Experience reading and interpreting insurance cards, benefit summaries, and payor portals.
• Proficiency with EMR/PM systems and basic office software (e.g., Excel, Word, email).
• Strong attention to detail, organization, and documentation skills.
• Excellent communication skills, with the ability to explain complex benefit information in plain language.
• Ability to manage multiple referrals and deadlines in a fast-paced environment with minimal errors.

Key competencies

• Detail-oriented: Accurately captures and documents benefit and authorization information.
• Customer focus: Communicates clearly and professionally with patients, referral sources, and internal teams.
• Problem solving: Anticipates coverage issues and proposes options or alternatives.
• Teamwork: Partners effectively with intake, clinical, and billing to move referrals to start of care.
• Confidentiality: Handles PHI and financial information responsibly and in compliance with all regulations.

Salary : $21 - $28