Insurance Verification & Authorization Specialist

The role

This person will verify insurance eligibility, obtain prior authorizations, and manage PCP referrals. They will support revenue cycle and patient intake operations.

What you will do

• Verify patients' insurance eligibility and active coverage.
• Review insurance benefits including deductibles, copayments, coinsurance, and out-of-pocket expenses.
• Confirm in-network and out-of-network benefits and provider participation.
• Determine whether prior authorizations or PCP referrals are required.
• Submit authorization requests and follow up with insurance companies.
• Track authorization status, approval dates, expiration dates, and approved service periods.
• Contact PCP offices to request and obtain required referrals.
• Follow up with provider offices and insurance companies on outstanding referrals.
• Maintain accurate and timely documentation in electronic systems.
• Protect confidential patient information and comply with HIPAA requirements.

Required qualifications

• Previous hands-on experience in the medical field
• Experience with medical insurance eligibility and benefits verification
• Experience checking and obtaining prior authorizations
• Experience submitting PCP referrals and following up with provider offices
• Knowledge of commercial insurance and government healthcare plans, such as Medicare and Medicaid
• Understanding of in-network benefits, deductibles, coinsurance, referral requirements, and authorization processes
• Strong organizational skills and attention to detail
• Excellent written and verbal communication skills
• Ability to manage multiple requests and follow up on outstanding items without constant supervision
• Proficiency with computers, spreadsheets, and electronic documentation systems
• Ability to handle confidential patient information in accordance with HIPAA requirements

Nice to have

• Experience working with durable medical equipment (DME), medical supplies, or healthcare revenue cycle operations
• Experience with insurance portals and eligibility verification tools
• Familiarity with electronic health records (EHRs), practice management systems, and ticketing or CRM platforms
• Experience working directly with insurance companies, medical offices, and provider referral departments

About the company

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