Insurance Verification Specialist

SUMMARY:

The Insurance Verification Specialist is responsible for reviewing and processing incoming referrals from external providers to ensure timely access to care, primarily for new patients as well as occasionally for existing patients. This role is critical in initiating the patient care journey, working closely with referring offices, clinical teams, and patients to verify information, obtain past medical records and imaging, and schedule new patient appointments.

KEY RESPONSIBILITIES:

REFERRAL INTAKE & DOCUMENTATION

• Receive and process inbound referrals from external providers via eFax, EMR, phone, email, or third-party platforms.
• Review referral documents for completeness and accuracy, including diagnosis, insurance, and provider information.
• Input referral data into the EMR (e.g., eClinicalWorks), create patient’s chart, and promptly reach out to schedule.
• Monitor open referrals, making repeated contact attempts to patient over several days via call and text until scheduled.
• Track reasons referrals are not scheduled within the EMR and provide updates back to referring provider partners.
• Field incoming calls from referral sources, referred new patients, and self-referrals to coordinate scheduling process.
• Screen self-referrals (patients who found us online or through word-of-mouth) to understand their condition and past treatment history based on our patient criteria and defined screening scripts prior to scheduling.

PATIENT SUPPORT

• Contact patients to inform them of appointment details, pre-visit instructions, and next steps.
• Provide guidance on navigating referred services (e.g., imaging centers, specialists).
• Address patient questions and coordinate logistics to minimize delays.

COMMUNICATION & COLLABORATION

• Liaise with external offices and provider groups to ensure seamless referral handoffs.
• Partner with clinical teams to confirm the accuracy of referral orders and urgency.
• Escalate any issues or delays to appropriate clinical or administrative staff.

PROFESSIONAL QUALIFICATIONS:

• High school diploma or equivalent required; associate degree or healthcare training a plus.
• 1–2 years of experience in a healthcare referral, scheduling, or front office coordination role.
• Working knowledge of insurance requirements and prior authorization protocols.
• Strong communication, customer service, and organizational skills.
• Experience with electronic medical records (eCW preferred).
• Ability to multitask while maintaining accuracy and attention to detail.