What are the responsibilities and job description for the Medical Insurance Verification Specialist position at Weston Med Spa & Cosmetic Surgery LLC?
Position Summary:
The Verification of Benefits (VOB) Specialist is responsible for accurately verifying patient insurance coverage, benefits, and authorization requirements for services related to in vitro fertilization (IVF), gynecological (GYN), and obstetrical (OB) care. This role ensures all required information is obtained prior to services being rendered, supports proper billing workflows, minimizes claim denials, and provides clear financial expectations to patients—including in-person discussions of case rates and coverage.
Key Responsibilities:
- Verify patient insurance benefits for IVF, GYN, and OB services, including coverage, copays, coinsurance, deductibles, and out-of-pocket maximums
- Review and interpret infertility benefits, including lifetime maximums, cycle limits, medication coverage, and exclusions
- Perform comprehensive OB benefit verification, including understanding and explaining global OB billing and what services are included/excluded
- Determine and communicate patient financial responsibility for OB case rates and IVF-related services
- Conduct face-to-face interactions with patients to review benefits, explain coverage, and go over case rates and financial expectations
- Confirm requirements for prior authorizations, referrals, and medical necessity for procedures, including ultrasounds including MFM and fertility-related services
- Verify and obtain authorizations for all ultrasound services and ensure accuracy based on CPT requirements
- Review and interpret insurance policies, including commercial, Medicare, Medicaid, and HMO/PPO plans
- Identify discrepancies in benefit information and follow up with insurance carriers for clarification or correction
- Document all verification details thoroughly and accurately in the practice management system
- Communicate verified benefits and any potential issues to front desk, clinical staff, and billing department
- Proactively identify coverage limitations or high patient responsibility and escalate concerns prior to services
- Assist in resolving authorization and eligibility issues to prevent claim denials
- Stay current on payer guidelines, coding updates, and policy changes related to IVF, GYN, and OB services
Required Qualifications:
- Minimum 2 years of experience in medical insurance verification, benefits, or revenue cycle management
- Working knowledge of IVF, GYN, and OB services
- Strong understanding of OB global billing and case rate structures
- Experience with infertility insurance benefits and authorization requirements
- Strong understanding of insurance terminology (deductibles, coinsurance, COB, TPL, etc.)
- Experience with commercial, Medicare, and Medicaid plans
- Familiarity with CPT, ICD-10 coding, and payer guidelines
- Strong attention to detail and accuracy
- Excellent communication skills, including ability to explain complex financial information to patients clearly and professionally
Preferred Qualifications:
- Experience in OB/GYN, reproductive endocrinology, or fertility practice
- Experience discussing financial responsibility and setting up payment plans
- Familiarity with ATHENA / EMR/Practice Management systems
Work Environment:
- Fast-paced medical office or billing department
- Requires frequent communication with insurance providers, patients, and internal staff
- Combination of administrative duties and direct patient interaction
Pay: From $18.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
Work Location: In person
Salary : $18