About the role
Role Overview
We are seeking an experienced Insurance Verification Specialist to support U.S.-based healthcare providers with verifying patients’ insurance coverage and benefits. The ideal candidate has hands-on experience working with U.S. healthcare insurance plans, confirming eligibility, reviewing coverage details, and communicating with insurance companies to ensure accurate patient information and smooth administrative workflows.
Key Responsibilities:
1. Verify patients’ insurance eligibility and active coverage before scheduled appointments or medical procedures.
2. Contact insurance providers to confirm benefits, copayments, coinsurance, deductibles, out-of-pocket maximums, and coverage limitations.
3. Review insurance policies to determine covered services, exclusions, and referral or authorization requirements.
4. Update and maintain accurate patient insurance information in electronic health records (EHRs) and practice management systems.
5. Identify and resolve insurance discrepancies, inactive policies, and missing or incorrect patient information.
6. Communicate insurance benefits and financial responsibilities to patients and internal healthcare teams as needed.
7. Coordinate with billing, scheduling, and prior authorization teams to ensure insurance requirements are met.
8. Document verification results, reference numbers, and communication details accurately.
9. Follow up with insurance companies regarding pending eligibility or coverage questions.
10. Maintain patient confidentiality and comply with HIPAA regulations and organizational policies.
Qualifications and Requirements:
1. Proven experience in insurance verification for U.S.-based healthcare providers, medical practices, hospitals, or healthcare organizations.
2. Strong understanding of U.S. health insurance plans, including commercial insurance, Medicare, and Medicaid.
3. Experience verifying eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations.
4. Valid HIPAA certification and a solid understanding of patient privacy and confidentiality requirements.
5. Familiarity with electronic health records (EHRs), practice management systems, and insurance verification portals.
6. Strong English communication skills, both written and verbal, particularly when communicating with U.S. insurance representatives.
7. Ability to manage multiple verification requests, meet deadlines, and maintain accurate documentation.
8. Reliable internet connection and a suitable home-based work environment.
Work Requirements:
1. Ability to work remotely while supporting U.S. healthcare operations.
2. Willingness to work in alignment with the assigned U.S. time zone.
3. Commitment to maintaining data accuracy, protecting sensitive patient information, and following established procedures.